Beta-blockers in acute myocardial infarction: A comprehensive analysis

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Created On: 03/02/2025

A robust, multi-center, open-label, parallel-group trial sought to investigate the usefulness of beta-blockers for post-infarction care.

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Key take away

Long-term beta-blocker treatment fails to lessen the likelihood of death or new myocardial infarction in people with acute myocardial infarction and preserved left ventricular ejection fraction of at least 50%.

Background

A robust, multi-center, open-label, parallel-group trial sought to investigate the usefulness of beta-blockers for post-infarction care.

Method

This trial spanning 45 centers across Estonia, New Zealand, and Sweden, enrolled acute myocardial infarction sufferers. These individuals had undergone coronary angiography and had a left ventricular ejection fraction (≥50%). Volunteers were randomly allocated to get either long-term beta-blocker therapy (Metoprolol or Bisoprolol) or no treatment. The composite of mortality from any cause or a novel myocardial infarction was the key outcome ascertained.

Result

Overall, 5020 patients were enrolled, with 95.4% hailing from Sweden. The median follow-up period was 3.5 years. The primary outcome was comparable in both groups (hazard ratio, 0.96), as shown in Table 1:

Surprisingly, beta-blocker use did not markedly diminish the incidence of secondary endpoints, including death from any cause (3.9% vs. 4.1%), cardiovascular death (1.5% vs. 1.3%), myocardial infarction (4.5% vs. 4.7%), or hospitalizations for atrial fibrillation (1.1% vs. 1.4%) and heart failure (0.8% vs. 0.9%).

On the safety front, adverse events like bradycardia, atrioventricular block, hypotension, syncope, or pacemaker implantation occurred in 3.4% of subjects in the beta-blocker group and 3.2% in the no-beta-blocker group, with hospitalizations for asthma, chronic obstructive pulmonary disease, and stroke being comparable between the two groups.

Conclusion

In patients with acute myocardial infarction, long-term beta-blocker therapy showed no benefit in mitigating the risk of death from any cause or a new myocardial infarction when compared to those not receiving beta-blockers. These findings challenge the traditional role of beta-blockers in post-myocardial infarction care, sparking further debate on their long-term utility in this setting.