N Engl J Med

ACC 2024: Are beta-blockers beneficial after MI in patients with preserved EF?

April 7, 2024

Among patients with acute myocardial infarction (MI) who underwent early coronary angiography and had a preserved ejection fraction (EF), long-term use of beta-blockers didn’t lead to a lower risk of the composite end point of all-cause mortality or new MI.

In the parallel-group, open-label REDUCE-AMI trial, investigators randomly assigned patients with an acute MI who’d undergone coronary angiography and had a left ventricular EF of ≥50% to receive either long-term treatment with a beta-blocker (metoprolol or bisoprolol) or no beta-blocker treatment. Primary end point was a composite of death from any cause or new MI.

Between September 2017 and May 2023, a total of 5,020 patients were enrolled (95.4% from Sweden). Median follow-up was 3.5 years. Rate of a primary end-point event was 7.9% in the beta-blocker group vs. 8.3% in the no–beta-blocker group (hazard ratio, 0.96; 95% confidence interval, 0.79-1.16; P=0.64).

For secondary endpoints, beta-blocker therapy didn’t appear to lower cumulative incidence of the following:

• death from any cause: 3.9% in beta-blocker group vs. 4.1% in no–beta-blocker group
• death from CV causes: 1.5% vs. 1.3%
• MI: 4.5% vs. 4.7%
• hospitalization for afib: 1.1% vs. 1.4%
• hospitalization for heart failure: 0.8% vs. 0.9%

Regarding safety end points:

• hospitalization for bradycardia, second- or third-degree AV block, hypotension, syncope, or pacemaker implantation: 3.4% in beta-blocker group vs. 3.2% in no–beta-blocker group
• hospitalization for asthma or COPD: 0.6% vs. 0.6%
• hospitalization for stroke: 1.4% vs. 1.8%

Source:

Yndigegn T, et al. (2024, April 7). N Engl J Med. Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction. https://www.nejm.org/doi/full/10.1056/NEJMoa2401479