Impact of Beta Blockade Therapy on Long-Term Mortality After ST-Segment Elevation Acute Myocardial Infarction in the Percutaneous Coronary Intervention Era

Are beta blockers still necessary for all survivors of acute myocardial infarction?

“…Although this study by Dondo et al has a limitation that almost 95% of the study subjects had received BB, which likely affected the results as a medication bias even after the state-of the art statistical analysis, their findings were consistent with recent analyses (16)(17)(18)(19) and likely true in the contemporary PCI era.…”

“…For example, the 2-year mortality rates in the Cooperative Cardiovascular Project, a retrospective analysis including over 200,000 post-MI patients, were 14.4% and 23.9% for those treated with BB and those without BB, respectively, even among low-risk individuals (4). In contrast, the overall mortality rates during a median followup period of 1,430 days in the OACIS study (17) were only 5.2% and 6.2 % in the BB and non-BB groups, respectively, and particularly, mortality rates in non-BB group patients at low risk [Global Registry of Acute Coronary Events (GRACE) risk score (24) <121] was only 3.6%, which is significantly lower than those in the pre-reperfusion or thrombolytic eras (4,5). Importantly, however, even in the contemporary PCI era, the results from the OACIS study (17) also indicated benefits of BB therapy at discharge for high-risk patients: subgroup analyses among matched populations revealed that BB treatment was associated with a significantly decreased mortality for high-risk patients, who were defined as those with GRACE risk scores ≥121 or those administered diuretics, but not for lower risk patients (Figure 1), indicating that implementation of BB therapy for STEMI survivors may need to be assessed on the basis of individual mortality risk in the PCI era.…”

“…In the Osaka Acute Coronary Insufficiency Study (OACIS) (17,(20)(21)(22)(23), we recently reported that mortality rates did not differ between patients with and without BB therapy (5.2% vs. 6.2%, P=0.786) during a median follow-up period of 1,430 days (adjusted hazard ratio 0.935, 95% confidence interval 0.711 to 1.230, P=0.534) in 5,628 consecutive survivors for STEMI admitted within 24 hours after onset and treated with primary PCI, which was confirmed in the matching cohort selected using propensity score (N=3,846, hazard ratio 0.834, 95% confidence interval 0.643 to 1.082, P=0.171) (17). Ozasa et al also reported a similar finding from the J-Cypher Registry that BB was not associated with better 3-year clinical outcomes in 910 STEMI patients who underwent PCI within 24 hours from the onset (18).…”

Relationship Between β‐Blocker Therapy at Discharge and Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

“…Predecessors have highlighted the importance of β‐blocker therapy in patients with acute myocardial infarction 18, 19, 20, 21, 22, 23, 24. However, there are a few studies reporting that β‐blocker use is not associated with improved outcome 25, 26, 27. One meta‐analysis of randomized trials on the clinical outcomes of β‐blocker use indicated no mortality benefit but reduced recurrent myocardial infarction and angina (short‐term) at the expense of increased heart failure, cardiogenic shock, and drug discontinuation 28.…”

Is it Time to Repair a Fairly Fast SAAB Convertible? Testing an Evidence-based Mnemonic for the Secondary Prevention of Cardiovascular Disease

“…31,32 In patients with normal left ventricular function, AHA/ACCF secondary prevention guidelines recommend beta-blocker therapy for at least three years and suggest ongoing treatment is reasonable (Class IIa, Level of evidence B). 9 Recently reported French registry data suggested there may be no additional mortality benefits from beta blockers beyond the first 12 months after an MI in patients with preserved systolic function (LVEF>40%), although likely confounding of this observational data has been raised as a major limitation in drawing strong conclusions.…”