Comparison of Outcomes with or without Beta-Blocker Therapy After Acute Myocardial Infarction in Patients Without Heart Failure or Left Ventricular Systolic Dysfunction (from the Acute Coronary Syndromes Israeli Survey [ACSIS])

Beta-blockers are recommended as a standard treatment for patients who experience a myocardial infarction (MI). However, the evidence supporting this recommendation is based on the prereperfusion era data. This review aims to evaluate the effectiveness of long-term ($1 year) beta-blocker therapy in post-MI patients without clinical heart failure (HF) in the reperfusion era. We included observational cohort studies, which compared at least 1 year use of beta-blockers to no beta-blockers in patients with an acute MI, but without HF. The clinical endpoint considered was all-cause mortality, except for cardiovascular death in one study. Five cohort studies and 217,532 patients were included. One study demonstrated a reduction in all-cause mortality with beta-blockers, whereas, in 4 studies, there was no difference in the death rate. The pooled estimate by random effect showed that beta-blocker treatment does not reduce mortality (odds ratio 0.800, 95% confidence interval 0.559-1.145) with high heterogeneity (I2 = 94%). This metaanalysis shows that the use of oral beta-blockers for 1 year or more does not reduce the mortality of MI patients without HF. Large randomized trials need to evaluate beta-blocker discontinuation after an acute MI.

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“…Twenty-one of these did not fulfill the inclusion criteria, and 5 studies. [7][8][9]13,14 were included in the meta-analysis (Fig. 1).…”

Section: Study Selectionmentioning

confidence: 99%

Long-Term Beta-Blocker Therapy After Myocardial Infarction Without Heart Failure in the Reperfusion Era—Systemic Review and Meta-analysis

Kim

Byun

Kim

et al. 2022

Journal of Cardiovascular Pharmacology

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“…When 50 patients who died due to CV events are distributed according to their diagnoses, 13 (3.8%) of 339 patients were diagnosed with UAP (mean follow-up of 30.02 ± 7.41 months), 19 (9,2%) of 206 patients with NSTEMI (mean follow-up of 30 ± 9.21 months), and 18 (5.1%) of 356 patients with STEMI (mean follow-up of 29.86 ± 8.62 months). During follow-up, 26% (13) of CVrelated deaths were seen in the UAP group, 38% (19) in the NSTEMI group, and 36% (18) In hospital Mortality of Acute Coronary Syndrome worse in the NSTEMI group. The frequency of death, re-infarction, stroke and CABG was found to be higher in the NSTEMI group (p < 0.0001).…”

Section: Discussion Discussionmentioning

confidence: 97%

“…One-year survival was not significantly different between beta-blockers users and non-users (HR 0.8, 95% CI 0.58 to 1.11, p = 0.18). 19 In the GULF-COAST trial (a prospective multicenter cohort of ACS) in-hospital, 6-month and 12-month mortality were studied, in relation to beta blocker use: prior to admission, 24-hour post-admission and on discharge. Patients with LVEF > 40% were included in the study.…”

Section: Discussion Discussionmentioning

confidence: 99%

Retrospective Evaluation of In-Hospital and Thirty-Month Mortality Parameters in Cases of Acute Coronary Syndrome

ALAN

KAYIKÇIOĞLU

ALAN

2022

DAHUDER Medical Journal

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Objectives: The aim of this study is to retrospectively assess, from the hospital records of patients, the clinical data of patients and the treatment strategies practiced on patients who were diagnosed as Acute Coronary Syndrome (ACS) and hospitalized and treated in the Hospital of Faculty of Medicine to research the effect of these data on occurrence of cardiovascular events and 30 months mortality. Methods: It is a retrospective screening study in which patients hospitalized with the diagnosis of ACS between June 2007 and December 2008 in the Hospital of Faculty of Medicine Cardiology Clinic are evaluated by using patient file information and electronic data recording system information, and by calling patients. In-hospital and long-term follow-up deaths were the endpoints of the study. Statistical analysis was performed using SPSS (Version 15.0). Results: 985 patients were included in the study who were diagnosed as ACS, hospitalized and treated in the hospital. The categorization of the patients subjected to the analysis (n:901) according to their diagnosis is as follows: 339 (38%) cases diagnosed as UAP, 206 (23%) cases diagnosed as NSTEMI, and 356 (39%) cases diagnosed as STEMI. 78,4 % of cases were male while 21,6 % were female. It was found that cases with hypertension, hyperlipidemia, obesity risk factor, and with a history of cardiovascular disease fall into the NSTEMI and UAP groups with a larger proportion. Among the groups, the UAP diagnosed cases have the largest and the STEMI diagnosed cases have the smallest ratio of using medicine groups such as beta blocker, calcium-canal blocker, ACE inhibitor, ARB, diuretic, statin, fibrate and nitrate before being hospitalized. In-hospital mortality was frequently encountered with a percentage of 7.6 % in STEMI cases, 2.4 % in NSTEMI cases, and 0.6 % in UAP cases. 30-months of follow-up data were obtained in all diagnosis groups for long-term mortality assessment. 70 (7.8 %) deaths were observed within the follow-up. According to diagnosis groups, death was observed in 22 (6.5 %) of UAP cases, 22 (10.7 %) of NSTEMI cases, and 26 (7.3 %) of STEMI cases. Correlation between long-term survival (30 months) and in-hospital statin usage and statin usage in discharge was not significant (p value respectively 0.1 and 0.16). Correlation between an approximate 30-months-survival and in-hospital ACE inhibitor/ARB inhibitor usage and ACE inhibitor/ARB inhibitor usage during discharge was significant (p = 0.007 and p = 0.004). It is also found that there was a significant correlation between survival in the same period of time and in-hospital beta blocker usage (p = 0.01). There was not a significant correlation between beta blocker usage during discharge and long-term survival (p = 0.779). Conclusion: Results of the unicentral retrospective scanning study which involves 901 ACS diagnosed patients prove to be similar to the ones obtained from GRACE and Euro Heart Survey prospective studies which were carried out in multi-central environment and among outnumbered patients.

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“…However, its role in secondary prevention following MI has been questioned in the contemporary reperfusion era. 1 , 2 , 10 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 Moreover, current guidelines also did not clearly address the role of chronic BB therapy and its optimal duration in stabilized patients after AMI. The 2011 American Heart Association/American College of Cardiology guideline for secondary cardiovascular prevention 20 encouraged BB therapy beyond 3 years as chronic therapy in all patients, including patients with preserved LVEF who have had MI, as a class IIa recommendation.…”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Long‐Term Maintenance Beta‐Blocker Therapy After Acute Myocardial Infarction in Stable, Optimally Treated Patients Undergoing Percutaneous Coronary Intervention

Lee

Kim

et al. 2023

JAHA

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Background The benefits of long‐term maintenance beta‐blocker (BB) therapy in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) have not been well established. Methods and Results Using the Korean nationwide registry, a total of 7159 patients with AMI treated with PCI who received BBs at discharge and were free from death or cardiovascular events for 3 months after PCI were included in the analysis. Patients were divided into 4 groups according to BB maintenance duration: <12 months, 12 to <24 months, 24 to <36 months, and ≥36 months. The primary outcome was the composite of all‐cause death, recurrent MI, heart failure, or hospitalization for unstable angina. During a mean 5.0±2.8 years of follow‐up, over half of patients with AMI (52.5%) continued BB therapy beyond 3 years following PCI. After propensity score matching and propensity score marginal mean weighting through stratification, a stepwise inverse correlation was noted between BB duration and risk of the primary outcome (<12 months: hazard ratio [HR], 2.19 [95% CI, 1.95–2.46]; 12 to <24 months: HR, 2.10 [95% CI, 1.81–2.43];, and 24 to <36 months: HR, 1.68 [95%CI, 1.45–1.94]; reference: ≥36 months). In a 3‐year landmark analysis, BB use for <36 months was associated with an increased risk of the primary outcome (adjusted HR, 1.59 [95% CI, 1.37–1.85]) compared with BB use for ≥36 months. Conclusions Among stabilized patients with AMI following PCI, longer maintenance BB therapy, especially for >36 months, was associated with better clinical outcomes. These findings might imply that a better prognosis can be expected if patients with AMI maintain BB therapy for ≥36 months after PCI. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02806102.

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Comparison of Outcomes with or without Beta-Blocker Therapy After Acute Myocardial Infarction in Patients Without Heart Failure or Left Ventricular Systolic Dysfunction (from the Acute Coronary Syndromes Israeli Survey [ACSIS])

Cited by 6 publications

References 19 publications

Long-Term Beta-Blocker Therapy After Myocardial Infarction Without Heart Failure in the Reperfusion Era—Systemic Review and Meta-analysis

Long-Term Beta-Blocker Therapy After Myocardial Infarction Without Heart Failure in the Reperfusion Era—Systemic Review and Meta-analysis

Retrospective Evaluation of In-Hospital and Thirty-Month Mortality Parameters in Cases of Acute Coronary Syndrome

Comparative Effectiveness of Long‐Term Maintenance Beta‐Blocker Therapy After Acute Myocardial Infarction in Stable, Optimally Treated Patients Undergoing Percutaneous Coronary Intervention

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