The effect of discontinuing beta-blockers after different treatment durations following acute myocardial infarction in optimally treated, stable patients without heart failure: a Danish, nationwide cohort study

Abstract

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 two 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 one year or later after a myocardial infarction without heart failure was not associated with increased serious adverse events.

Temporal characteristics and associated factors of discontinuation and outcomes after percutaneous coronary intervention

“…On the other hand, it suggests that permanent discontinuation after PCI has a nonsignificant effect on MACE, which is inconsistent with the results of previous studies and may be related to the design of our telephone survey ( Xie et al, 2019 ). In clinical practice, certain medications, such as P2Y12 inhibitors and β-blockers, can be discontinued under physician supervision at specific times after PCI in certain patients without being associated with an increased risk of MACE ( Sorrentino et al, 2020 ; Redfors et al, 2022 ; Halili et al, 2023 ; Kinlay et al, 2023 ; Park et al, 2023 ). Our telephone survey did not differentiate between the types of medications discontinued by self-administration, which may have led patients to confuse self-discontinuation with physician-guided discontinuation and to categorize physician-guided discontinuation as self-discontinuation.…”