Key result
Post-ACS beta-blockers show no clear long-term survival benefit, extending 1-year RMST by only ~6 days.
Why the study?
The association between beta-blocker prescription and long-term all-cause mortality after ACS across the LVEF spectrum was uncertain.
Does beta-blocker prescription at discharge improve long-term survival across the ejection fraction spectrum in patients after acute coronary syndrome?
Cohort (n=6,049)
Yes
Does beta-blocker prescription at discharge improve long-term survival across the ejection fraction spectrum in patients after acute coronary syndrome?
Discharge beta-blocker prescription after acute coronary syndrome was not associated with a clear long-term survival advantage, adding to growing evidence that challenges routine long-term use, especially in patients without reduced ejection fraction.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Taken together, [the] findings suggest that any survival advantage associated with BB [beta-blocker] therapy in contemporary ACS populations is likely modest, may be concentrated among patients with impaired LV systolic function, and may be largely confined to the early post-discharge period," the researchers wrote.”
Suggests possible short-term survival benefit with beta-blockers in reduced-EF ACS; leaves open long-term effects and utility in preserved EF.
Aims To evaluate the association between beta-blocker (BB) prescription and long-term all-cause mortality after acute coronary syndrome (ACS), and to assess whether this varies across the left ventricular ejection fraction (LVEF) spectrum. Methods We analysed ACS patients from the retrospective multicentre CardioMining study (NCT05176769). The primary analysis used inverse probability of treatment weighting (IPTW) and restricted mean survival time (RMST) derived from weighted Kaplan-Meier curves. RMST and survival differences were estimated at 1 and 5 years. A landmark analysis evaluated survival between years 1 and 5 among first-year survivors. Results Among 6,049 ACS patients (age 66.8±13.2 years; 74.9% male), 5,107 (84.4%) were discharged on BBs. During a median 4.6-year follow-up, 1,912 deaths (31.6%) occurred. Overall, the 1-year RMST difference associated with BBs was 6.3 days (95%CI 0.0 to 13.2), which attenuated further by 5 years (11.3 days, 95%CI -30.7 to 63.9). The largest 1-year RMST difference was observed among patients with LVEF≤40% (18.8 days, 95%CI 1.1 to 37.4), whereas associations were smaller and non-significant among patients with LVEF 41-49% and LVEF≥50%. At 5 years, confidence intervals crossed the null across all LVEF categories. Continuous LVEF analyses suggested greater short-term benefit at lower values, with progressive attenuation across the LVEF spectrum. Among 1-year survivors, no significant RMST differences were observed between years 1 and 5. Conclusion Discharge BB prescription was not associated with a clear long-term survival advantage after ACS in this large real-world cohort. Apparent associations were strongest at lower LVEF values and attenuated during longer follow-up.
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Tsiartas et al. (2026) conducted a cohort in Acute coronary syndrome (ACS) (n=6,049). Beta-blocker prescription at discharge vs. No beta-blocker prescription was evaluated on All-cause mortality evaluated via restricted mean survival time (RMST) difference at 1 year (RMST difference 6.3 days, 95% CI 0.0 to 13.2). Beta-blocker prescription after acute coronary syndrome was not associated with a clear long-term survival advantage, showing only a 1-year RMST difference of 6.3 days (95% CI 0.0-13.2).
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