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])

https://doi.org/10.1016/j.amjcard.2020.12.044Get rights and content

The contemporary benefit of routine beta-blocker therapy following myocardial infraction in the absence of heart failure or left ventricular systolic dysfunction is unclear. We investigated the impact of beta-blockers on post myocardial infarction outcome in patients without heart failure or left ventricular systolic dysfunction among patients enrolled in the biennial Acute Coronary Syndrome Israeli Surveys. MACE rates at 30 days and overall mortality at one year were compared among patients discharged on beta-blockers versus not, after multivariate analysis to adjust for baseline differences. Between the years 2000 to 2016, data from 15.211consecutive ACS patients were collected. Of 7,392 patients who met the inclusion criteria, 6007 (79.9%) were discharged on beta-blocker therapy. Prescription of beta-blockers at discharge increased modestly from 32% to 38% over the 16-year period. The 30-day MACE rates were similar in patients on vs. not on beta-blockers at discharge (9.0% and 9.5%, respectively). One year survival did not differ significantly between those on vs. not on beta-blockers (HR 0.8, 95% CI 0.58 to 1.11, p = 0.18).In conclusion, beta-blocker therapy did not affect 30 days MACE or 1-year survival after myocardial infarction in patients without heart failure or reduced ejection fraction.

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Methods

We collected data from the ACSIS survey conducted between the years 2000-2016. Briefly, the ACSIS Registry, started in 2000, is a 2-month nationwide survey conducted biennially which prospectively collects data from all consecutive ACS admissions in all 25 coronary care units in Israel. Patient management was at the discretion of the attending physicians. Eligibility for the registry was validated before discharge from the coronary care units. Discharge diagnoses were recorded as determined by

Results

Between 2000 and 2016 15.211ACS patients were included in ACSIS (Figure 1). There were 7,392 post MI patients without heart failure or LVSD, including 4580 patients with an EF above 50% and 2812 with an EF between 40-49%. The proportion of NSTEMI/UA patients was slightly higher compared with STEMI, 52.8% and 47.2% respectively. The vast majority of patients underwent PCI during the index admission. Small proportions of patients were referred for CABG or treated medically (4.6% and 8.1%,

Discussion

Our current study shows that in a real life, nationwide prospective cohort of consecutive patients admitted with an ACS without heart failure or LVSD, beta-blocker therapy at discharge was not associated with better 30-day MACE or 1-year mortality. Moreover, no benefit of beta-blockers was found in various subgroups, including EF (>50% and 40% to 49%), type of MI or heart rate. The benefit of beta blockers following MI was established during the 1970s and 1980s. With contemporary reperfusion

Disclosures

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this study.

Credit Author Statement

Author agreement/statement: Aref El Nasasra, MD: writing original draft, completion final draft and editing. Roy Beigel, MD: writing review and editing. Robert Klempfner, MD: writing review; Hilmi Alnsasra, MD: writing review and editing; Shlomi Matetzky, MD: writing review. Zaza Iakobishvili, MD: writing review. Ronen Rubinshtein, MD: writing review. Majdi Halabi, MD: writing review. Alex Blatt, MD: writing review; Doron Zahger, MD: Conceptualization, Methodology, writing review and editing.

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