Effect of long-term beta-blocker treatment following myocardial infarction among stable, optimally treated patients without heart failure in the reperfusion era: a Danish, nationwide cohort study

Eur Heart J. 2021 Mar 1;42(9):907-914. doi: 10.1093/eurheartj/ehaa1058.

Abstract

Aims: We aimed to investigate the long-term cardio-protective effect associated with beta-blocker (BB) treatment in stable, optimally treated myocardial infarction (MI) patients without heart failure (HF).

Methods and results: Using nationwide registries, we included patients with first-time MI undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) during admission and treated with both acetyl-salicylic acid and statins post-discharge between 2003 and 2018. Patients with prior history of MI, prior BB use, or any alternative indication or contraindication for BB treatment were excluded. Follow-up began 3 months following discharge in patients alive, free of cardiovascular (CV) events or procedures. Primary outcomes were CV death, recurrent MI, and a composite outcome of CV events. We used adjusted logistic regression and reported standardized absolute risks and differences (ARD) 3 years after MI. Overall, 30 177 stable, optimally treated MI patients were included (58% acute PCI, 26% sub-acute PCI, 16% CAG without intervention). At baseline, 82% of patients were on BB treatment (median age 61 years, 75% male) and 18% were not (median age 62 years, 68% male). BB treatment was associated with a similar risk of CV death, recurrent MI, and the composite outcome of CV events compared with no BB treatment [ARD (95% confidence intervals)] correspondingly; 0.1% (-0.3% to 0.5%), 0.2% (-0.7% to 1.2%), and 1.2% (-0.2% to 2.7%).

Conclusions: In this nationwide cohort study of stable, optimally treated MI patients without HF, we found no long-term effect of BB treatment on CV prognosis following the patients from 3 months to 3 years after MI admission.

Keywords: Beta-blockers; Myocardial infarction; Over-treatment; PCI; Reperfusion era.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aftercare
  • Cohort Studies
  • Denmark / epidemiology
  • Female
  • Heart Failure* / drug therapy
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction* / drug therapy
  • Patient Discharge
  • Percutaneous Coronary Intervention*
  • Registries
  • Reperfusion
  • Risk Factors
  • Time Factors
  • Treatment Outcome