β-Blockers and Cardiovascular Events in Patients With and Without Myocardial Infarction

Abstract

Background-The long-term efficacy of β-blockers in patients with and without myocardial infarction (MI) is controversial. Methods and Results-This is post hoc analysis from the Clopidogrel for High Atherothrombotic Risk and IschemicStabilization, Management, and Avoidance (CHARISMA) trial of 4772 patients with prior MI, 7804 patients with known atherothrombosis, and 2101 patients with risk factors alone but without heart failure. Primary outcome was a composite of nonfatal MI, stroke, or cardiovascular mortality. The cohorts were divided into 2 groups based on baseline β-blocker use.In the propensity score-matched prior MI cohort, after 28 months of follow-up, β-blocker use was associated with a 31% 20).In the known atherothrombotic disease and the risk factors alone cohorts, β-blocker use was not associated with lower ischemic outcomes, whereas a trend toward a higher risk of stroke (3.5% versus 1.5%; hazards ratio, 2.13; 95% confidence interval, 0.92-4.92; P=0.079) was observed in the risk factors alone cohort. This higher stroke risk was significant in the regression model adjusted to the propensity score (hazards ratio, 2.69; 95% confidence interval, 1.33-5.44; P=0.006) and in the multivariable models. Conclusions-β-blocker use in patients with prior MI but no heart failure was associated with a lower composite cardiovascular outcome driven by lower risk of recurrent MI with no difference in mortality. However, β-blocker use was not associated with lower cardiovascular events in those without MI, with a suggestion of inferior outcome with regard to stroke risk. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00050817.(Circ Cardiovasc Qual Outcomes. 2014;7:872-881.)

Long-Term Anti-Hypertensive Therapy and Stroke Prevention: A Meta-Analysis

“…In a recent study by Bangalore et al [37], b-blocker use in patients with prior MI but no HF was associated with a lower composite cardiovascular outcome. These findings were driven by lower recurrent MI with no difference in mortality.…”

Trends for beta-blockers use in a large cohort of Polish hypertensive patients — Pol-Fokus Study

“…In a large study based on evaluation of electronic health records, it has been shown that use of beta-blockers among patients with new-onset coronary artery disease was associated with lower risk of cardiac events only among patients with a recent myocardial infarction [19]. Also in the post hoc analysis from the Clopidogrel for High Atherothrombotic Risk and Ischaemic Stabilization, Management, and Avoidance (CHARISMA) trial showed that beta-blocker use is not associated with lower cardiovascular events in those with coronary artery disease without prior myocardial infarction, with suggestion of inferior outcome with regard to stroke risk [20]. However, these findings have not been conferred in the guidelines [1][2][3].…”

Medical treatment of stable angina: A tailored therapeutic approach

“…In a post-hoc analysis of the CHARISMA trial, the use of beta-blockers in patients with prior MI but no heart failure was associated with a lower composite cardiovascular outcome driven by lower risk of recurrent MI with no difference in mortality [24]. In a meta-analysis of sixty trials with 102,000 patients the use of beta-blockers post-MI showed no mortality benefit, but it reduced recurrent myocardial infarction and angina (in the short term) with later increased rates of heart failure, cardiogenic shock, and drug discontinuation [25].…”