Long-Term Beta-Blocker Use Reduces Recurrent ACS After Myocardial Infarction

The following article is a part of conference coverage from the American Heart Association Scientific Sessions 2021, being held virtually from November 13 to 15, 2021. The team at Cardiology Advisor will be reporting on the latest news and research conducted by leading experts in cardiology. Check back for more from the AHA Scientific Sessions 2021.

Long-term use of beta-blockers in patients with acute coronary syndrome (ACS) and preserved left ventricular function is associated with a reduction in recurrent ACS, according to study results presented at the American Heart Association (AHA) Scientific Sessions 2021, held from November 13 to 15, 2021.

Investigators performed a retrospective observational study to determine if long-term use of beta-blockers is associated with risk for recurrent ischemic events or all-cause mortality. Researchers identified 4768 Canadian adults with non-ST-segment elevation myocardial infarction (NSTEMI; 2340) or ST-segment elevation myocardial infarction (STEMI; 2428) between 2008 and 2017 from relevant provincial databases.

Patients were included who had in-hospital left ventricular ejection fracture ≥50%, survived ≥180 days after index discharge, and received a new prescription for beta-blockers following ACS. The association between duration of beta-blocker use and primary composite outcomes of recurrent ACS, repeat revascularization, or all-cause mortality was determined using Cox proportional hazard models.

Of the 4768 patients, 1155 (24.2%) discontinued beta-blocker use before 180 days; 964 (20.2%) had a primary outcome event. Overall, early discontinuation of beta-blockers was not associated with increased risk for primary composite outcomes (adjusted hazard ratio [aHR], 1.13; 95% CI, 0.99-1.29; P =.07); however, it was associated with recurrent ACS (HR, 1.43; 95% CI, 1.164-1.756; P <.001).

When analysis was limited to the STEMI subgroup, early beta-blocker discontinuation was associated with increased risk for primary composite outcomes (HR, 1.27; 95% CI, 1.054-1.524; P =.01) driven by increased recurrent ACS risk. Repeat revascularization or all-cause mortality outcomes were not associated with early beta-blocker discontinuation.

The investigators suggested that beta-blocker use beyond 180 days in discharged patients with ACS and preserved left ventricular function may benefit patients with STEMI and can reduce risk for recurrent ACS. Early beta-blocker discontinuation was not associated with decreased risk for composite outcome events, according to researchers.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Chiu MH, Dong Y, Southern D, et al. Long-term prescription of beta-blockers after myocardial infarction with preserved left ventricular function is associated with reduction in recurrent ACS but not repeat revascularization or all-cause mortality. Presented at: AHA Scientific Sessions 2021; November 13-15, 2021. Poster P1.