Does discontinuation of beta-blockers increase the risk of adverse cardiovascular events or death in stable, optimally treated patients without heart failure following a first-time myocardial infarction?
Discontinuation of beta-blockers 1 year or later after a myocardial infarction in stable patients without heart failure is not associated with increased serious adverse events.
AIMS: We studied the effect of discontinuing beta-blockers following myocardial infarction in comparison to continuous beta-blocker use in optimally treated, stable patients without heart failure. METHODS AND RESULTS: Using nationwide registers, we identified first-time myocardial infarction patients treated with beta-blockers following percutaneous coronary intervention or coronary angiography. The analysis was based on landmarks selected as 1, 2, 3, 4, and 5 years after the first redeemed beta-blocker prescription date. The outcomes included all-cause death, cardiovascular death, recurrent myocardial infarction, and a composite outcome of cardiovascular events and procedures. We used logistic regression and reported standardized absolute 5-year risks and risk differences at each landmark year. Among 21 220 first-time myocardial infarction patients, beta-blocker discontinuation was not associated with an increased risk of all-cause death, cardiovascular death, or recurrent myocardial infarction compared with patients continuing beta-blockers (landmark year 5; absolute risk difference 95% confidence interval), correspondingly; -4.19% -8.95%; 0.57%, -1.18% -4.11%; 1.75%, and -0.37% -4.56%; 3.82%). Further, beta-blocker discontinuation within 2 years after myocardial infarction was associated with an increased risk of the composite outcome (landmark year 2; absolute risk 95% confidence interval 19.87% 17.29%; 22.46%) compared with continued beta-blocker use (landmark year 2; absolute risk 95% confidence interval 17.10% 16.34%; 17.87%), which yielded an absolute risk difference 95% confidence interval at -2.8% -5.4%; -0.1%, however, there was no risk difference associated with discontinuation hereafter. CONCLUSION: Discontinuation of beta-blockers 1 year or later after a myocardial infarction without heart failure was not associated with increased serious adverse events.
Halili et al. (Thu,) studied this question.