Study Questions Use of Beta-Blockers After AMI
Prescribing β-blockers after an acute myocardial infarction (AMI) might not be necessary for patients who do not have heart failure (HF) or left ventricular systolic dysfunction (LVSD), according to the researchers of a recent study. Their results indicated that β-blockers did not influence 1-year mortality outcomes in patients who were hospitalized with AMI without HF or LVSD.
The prospective, observational cohort study included 179,810 patients who were hospitalized with AMI without HF or LVSD between January 1, 2007 through June 30, 2013 from the Myocardial Ischaemia National Audit Project. Researchers followed participants until December 30, 2013 and used variable analyses to assess the association between β-blocker use and mortality outcomes at 1 month, 6 months, and 1 year.
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Over the course of the study, 9373 patients (5.2%) died.
A total of 88,854 of 91,895 patients (96.4%) with ST-segment elevation myocardial infarction (STEMI) received β-blockers, and 81,933 of 87,915 patients (93.2%) with non-ST-segment elevation myocardial infarction (NSTEMI) received β-blockers.
The unadjusted 1-year mortality for patients who received β-blockers was lower compared with patients with those who did not receive β-blockers (4.9% vs 11.2%, respectively).
However, weighted and adjusted analyses showed no significant differences in mortality outcomes between patients who received β-blockers and those who did not receive β-blockers. The researchers found similar results in analyses of STEMI and NSTEMI.
“Among patients who survived hospitalization in England and Wales with STEMI and NSTEMI without HF or LVSD, β-blocker use was not associated with lower all-cause mortality at any time point up to 1 year,” the researchers concluded. “This result adds to the increasing body of evidence that the routine prescription of β-blockers might not be indicated in patients with a normal ejection fraction or without HF after AMI.”
—Melissa Weiss
Reference:
Dondo TB, Hall M, West RM, et al. β-Blockers and mortality after acute myocardial infarction in patients without heart failure or ventricular dysfunction [published online May 29, 2017]. J Am Coll Cardiol. https://doi.org/10.1016/j.jacc.2017.03.578