PulseExploreJournal ClubResearchersJournals
Instagram
HomeJournal ClubExplore
Synapse
⌘+K
Synapse
September 12, 2026European Heart Journal - Quality of Care and Clinical Outcomes

Risk-Score Guided Estimation of Absolute Benefit From Beta-blockers after Myocardial Infarction in Patients Without Heart Failure

View Full Paper
Ask AI
Bookmark
Share

Why the study?

To evaluate whether a modified clinical risk score can stratify baseline risk and estimate absolute benefit from beta-blocker therapy after myocardial infarction in patients with LVEF ≥40%.

Does beta-blocker therapy reduce cardiovascular events in post-MI patients with LVEF ≥40%, and does the absolute benefit vary by baseline risk?

Population

5558 patients with a recent MI and LVEF ≥40%

Comparison

Beta-blocker vs no beta-blocker therapy across modified TRS-2P risk strata

Design

Substudy of a randomized controlled trial (BETAMI-DANBLOCK)

Follow-up

3-year

Key result

A modified TRS-2P risk score stratified absolute beta-blocker benefit in post-MI patients with LVEF ≥40%, with 3-year absolute risk reductions of 1.4%, 2.1%, and 3.6% across increasing risk strata.

Authors

HCHarun CaglarTHTherese HolmagerAKAnna Meta Dyrvig Kristensen

Discussion

Loading...

Member takes

Overview

Risk stratification may identify higher-benefit post-MI patients with LVEF ≥40%; leaves open randomized confirmation before practice change.

Key Points

  • To assess whether a modified clinical risk score can stratify baseline risk and estimate the absolute clinical benefit of beta-blocker therapy in post-myocardial infarction patients with preserved or mildly reduced left ventricular ejection fraction.
  • Conducted a substudy of the BETAMI-DANBLOCK randomized trial enrolling 5,558 post-myocardial infarction patients with left ventricular ejection fraction ≥40% randomized to beta-blocker or no beta-blocker therapy.
  • Categorized patients into low-, intermediate-, or high-risk strata using a modified Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS-2P).
  • Evaluated a composite primary endpoint (all-cause mortality, recurrent myocardial infarction, unplanned revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmia) using Cox and Fine-Gray models to determine 3-year absolute risk reduction (ARR) and number needed to treat (NNT).
  • Baseline categorization placed 38.4% of patients in the low-risk stratum, 52.8% in intermediate-risk, and 8.8% in high-risk groups, with no significant heterogeneity in relative effects across tiers (HR 0.88, HR 0.81, and HR 0.88, respectively).
  • Three-year ARR was 1.4% (NNT = 72; 95% CI, 41 to 361) in low-risk patients, 2.1% (NNT = 47; 95% CI, 27 to 239) in intermediate-risk patients, and 3.6% (NNT = 28; 95% CI, 16 to 140) in high-risk patients.

Study Design

Type

RCT (n=5,558)

Randomization

randomized

Structured PICO

Does beta-blocker therapy reduce cardiovascular events in post-MI patients with LVEF ≥40%, and does the absolute benefit vary by baseline risk?

P
Population
5,558 patients with a recent myocardial infarction and LVEF ≥40% evaluated for absolute benefit from beta-blocker therapy over 3 years.
I
Intervention
Beta-blocker therapy
C
Comparator
No beta-blocker therapy
O
Outcome
Composite of all-cause mortality, new-MI, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmiacomposite

A modified clinical risk score can stratify baseline risk in post-MI patients with LVEF ≥40% to identify those who derive the greatest absolute benefit from beta-blocker therapy.

Cite This Study

Caglar et al. (2026) conducted an RCT in Myocardial infarction with LVEF ≥40% (n=5,558). Beta-blocker therapy vs. No beta-blocker therapy was evaluated on Composite of all-cause mortality, new-MI, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmia. A modified TRS-2P risk score stratified absolute beta-blocker benefit in post-MI patients with LVEF ≥40%, with 3-year absolute risk reductions of 1.4%, 2.1%, and 3.6% across increasing risk strata.

synapsesocial.com/papers/6aa51ee4327956e4761f8cdfhttps://doi.org/10.1093/ehjqcco/qcag142
View Full Paper
Ask AI
Bookmark
Share