Beta-Blockers Most Effective Immediately Following Myocardial Infarction

While early β-blocker use following acute myocardial infarction (MI) was associated with reduced mortality, prolonged use offered no benefits, according to the results of a recent study.

Although the benefits of β-blockers in patients with heart failure or left ventricular dysfunction are undisputed, many trials assessing their use following acute MI are several decades old, conducted at a time when secondary prevention drugs such as statins were unavailable.
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To assess this association, researchers conducted a multicenter prospective cohort study of 2679 patients with acute MI and without heart failure or left ventricular dysfunction.

Mortality rates were assessed at 30 days in relation to early use of β-blockers, at 1 year, and at 5 years.

β-blockers were used early in 77% of patients, prescribed at discharge in 80%, and were still being used at 1 year in 89%. Overall, 30-day mortality was lower in patients who were given early β-blockers (hazard ratio, 0.46), while hazard ratio for 1-year mortality was 0.77. The use of β-blockers at 1 year was not associated with lower mortality rates at 5 years, although 5-year mortality was lower in patients who had still been taking statins at 1 year compared with those who had discontinued statins.

“Early β-blocker use was associated with reduced 30-day mortality in patients with acute myocardial infarction, and discontinuation of β-blockers at 1 year was not associated with higher 5-year mortality,” the researchers concluded. “These findings question the utility of prolonged β-blocker treatment after acute myocardial infarction in patients without heart failure or left ventricular dysfunction.”

—Michael Potts

Reference:
Puymirat E, Riant E, Aissoui N, et al. β blockers and mortality after myocardial infarction in patients without heart failure: multicentre prospective cohort study [published online September 20, 2016]. BMJ. doi:http://dx.doi.org/10.1136/bmj.i4801