Key result
Beta-blockers post-ACS show uncertain benefit in patients with preserved left ventricular function.
Why the study?
There are gaps in evidence regarding the use of beta-blockers after ACS in patients without left ventricular systolic dysfunction or EF <40%.
Beta-blocker use after ACS was associated with lower mortality across LVEF strata; leaves open need for randomized confirmation in preserved EF.
Despite significant advances in the management of acute coronary syndromes (ACS) over recent decades, there are still some gaps in evidence.The importance of beta-blockers in the context of pharmacological treatment during and after an ACS is well recognized.The indications concerning patients with left ventricular (LV) systolic dysfunction and ejection fraction (EF) <40% are clear.Unless there is a contraindication or the patient is in overt heart failure, the European and American guidelines confer a class I recommendation for beta-blocker use after both ST-and non-ST-segment elevation ACS (NSTE-ACS).1---4 The data are not as conclusive in patients without LV dysfunction.Several registries, meta-analyses and population-based studies question this indication, 5 especially in the setting of ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention.6 In their paper published in the current issue of the Journal, Velásquez-Rodríguez et al. focus on this issue.7 Despite the limitations of their observational study, which
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José Ilídio Moreira (2021) conducted an editorial in Acute coronary syndrome or myocardial infarction. Beta-blocker therapy was evaluated. This editorial discusses the ongoing clinical uncertainty regarding the benefit of beta-blocker therapy after acute coronary syndromes in patients without left ventricular systolic dysfunction.
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