Discontinuation of Beta-Blocker Therapy after Myocardial Infarction
View Full PaperWhy the trial?
Does discontinuation of beta-blocker therapy prevent a composite of death from any cause, recurrent myocardial infarction, or hospitalization for heart failure in patients who received beta-blocker therapy beyond the first year after a myocardial infarction?
Key result
Discontinuation of beta-blocker therapy beyond the first year after a myocardial infarction was noninferior to continuation for a composite of death, recurrent MI, or heart failure hospitalization.
Authors
Captured external expert commentary on this trial, strongest first. Original sources linked on every quote.
SMART-DECISION was the first RCT to demonstrate that discontinuing beta-blockers in stable post-MI patients without heart failure or LV dysfunction was noninferior to continuing treatment. At median follow-up of 3.1 years, the composite of death, MI, or HF hospitalization occurred in 7.2% of the discontinuation group vs 9.0% of the continuation group (HR 0.80; 95% CI 0.57-1.13; p=0.001 for noninferiority). The results contrast with the earlier ABYSS trial, which failed to meet noninferiority for beta-blocker interruption, generating meaningful debate about the role of long-term beta-blockers post-MI.
“In appropriately selected patients who survived a heart attack and do not have [HF] or left ventricular systolic dysfunction, routine continuation of beta-blockers indefinitely may not be necessary. In practice, for stable patients who are several years out from a heart attack, discontinuation can be considered through shared decision-making and with monitoring of blood pressure and heart rate. For patients with beta-blocker-related side effects – fatigue, dizziness, bradycardia, hypotension – the case for discontinuation is even stronger.”
“This is not definitive. Ours is only the first trial to demonstrate the safety of discontinuing beta-blockers in stable post-MI patients. We need more evidence.”
“These studies are changing our thinking. Does everyone need to be on a beta-blocker a year after the MI when they are stable and doing well? The patients with heart failure are obviously a different category if they have extensive damage, but I think this study is really making us question if we need to keep all patients on [beta-blockers].”
Supports deprescribing in stable post-MI patients with preserved EF; challenges guideline-endorsed indefinite continuation.
RCT
Does discontinuation of beta-blocker therapy prevent a composite of death from any cause, recurrent myocardial infarction, or hospitalization for heart failure in patients who received beta-blocker therapy beyond the first year after a myocardial infarction?
Discontinuation of beta-blocker therapy beyond one year post-myocardial infarction is noninferior to continuation for preventing major adverse cardiovascular events.
Choi et al. (2026) conducted an RCT in Myocardial infarction. Discontinuation of beta-blocker therapy vs. Continuation of beta-blocker therapy was evaluated on Composite of death from any cause, recurrent myocardial infarction, or hospitalization for heart failure. Discontinuation of beta-blocker therapy beyond the first year after a myocardial infarction was noninferior to continuation for a composite of death, recurrent MI, or heart failure hospitalization.