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September 23, 2026NEJM Evidence
Atenolol or Bisoprolol after Myocardial Infarction without Recorded Heart Failure
Key result
Atenolol post-MI without HF is associated with ~23% lower MACE risk versus bisoprolol.
- ATE 2.9 percentage points
- 95% CI 1.1-4.7
- n=11,558
Why the study?
The effect of different beta-blockers on outcomes of patients without heart failure after myocardial infarction is not well-studied.
Does atenolol reduce major adverse cardiovascular events compared to bisoprolol in patients with a new myocardial infarction without heart failure?
Population
11,558 patients aged 18 or older with new myocardial infarction without recorded heart failure in Paris area
Comparison
Atenolol initiated within 2 days of discharge vs bisoprolol initiated within 2 days of discharge
Design
Observational cohort study using French National Health Data System administrative data
Follow-up
Up to 2 years
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We believe that the evidence still supports beta blockers for patients with a large myocardial infarction that experience heart failure, but for patients with no signs of heart failure and a normal ejection fraction, this trial establishes that there's no indication that routine use of beta blockers is beneficial.”
Implication
May favor atenolol over bisoprolol for MACE reduction post-MI without HF; hypothesis-generating and requires RCT confirmation.
Key Points
- To compare two-year major adverse cardiovascular events and all-cause mortality between post-myocardial infarction patients without heart failure initiated on atenolol versus bisoprolol.
- Observational cohort study using French National Health Data System administrative data (Paris area, 2008–2018) of 11,558 post-myocardial infarction patients without recorded heart failure dispensed atenolol (N=1,523) or bisoprolol (N=10,035) within 2 days of discharge.
- Followed outcomes for up to 2 years and estimated average treatment effects (ATEs) using targeted maximum likelihood estimation for major adverse cardiovascular events (primary outcome) and all-cause mortality (secondary outcome).
- Major adverse cardiovascular events occurred in a weighted proportion of 10.8% in the atenolol group versus 14.1% in the bisoprolol group, with an average treatment effect of 2.9 percentage points (95% CI, 1.1 to 4.7).
- All-cause mortality occurred in a weighted proportion of 1.4% in the atenolol group versus 2.2% in the bisoprolol group, with an average treatment effect of 0.6 percentage points (95% CI, -0.2 to 1.3).
Study Design
Type
Cohort (n=11,558)
Multicenter
Yes
Structured PICO
Does atenolol reduce major adverse cardiovascular events compared to bisoprolol in patients with a new myocardial infarction without heart failure?
P
Population
11,558 adults hospitalized with a new myocardial infarction without prior heart failure, initiated on atenolol or bisoprolol within 2 days of discharge, followed for up to 2 years.
E
Exposure
Atenolol initiated within 2 days of hospital discharge
C
Comparator
Bisoprolol initiated within 2 days of hospital discharge
O
Outcome
Major adverse cardiovascular events (composite of cardiac arrest, all-cause mortality, reinfarction, stroke, or hospitalization for heart failure) followed for up to 2 yearscomposite
Main Result
Absolute Risk Reduction: 2.9 (95% CI 1.1–4.7)
Absolute Event Rate: 10.8% vs 14.1%
Absolute Risk Reduction: 2.9%
In patients with a new myocardial infarction without heart failure, initiation of atenolol was associated with a significantly lower risk of major adverse cardiovascular events at 2 years compared to bisoprolol.
Coverage & sources
Journal, society, and media accounts. Useful signal, not independent expert judgment.
Cite This Study
Laurenceau et al. (2026) conducted a cohort in Myocardial Infarction without Recorded Heart Failure (n=11,558). Atenolol vs. Bisoprolol was evaluated on major adverse cardiovascular events (cardiac arrest, all-cause mortality, reinfarction, stroke, or hospitalization for heart failure) (ATE 2.9 percentage points, 95% CI 1.1-4.7). Atenolol initiation after myocardial infarction without heart failure was associated with a lower risk of major adverse cardiovascular events compared with bisoprolol (ARR 2.9%; 95% CI 1.1-4.7).