Can Beta-Blockers Reduce Mortality in Acute Myocardial Infarction Without Heart Failure?

Beta-blocker use did not reduce mortality at 1 year in patients with acute myocardial infarction (AMI) without heart failure, according to a study published in the Journal of the American College of Cardiology.¹

Although beta-blocker use is the standard of care for AMI, their benefit in patients with AMI without heart failure has not been established.¹

“There is a knowledge gap about the clinical benefit of [beta- blockers] for patients with AMI who do not have heart failure,” study investigator Chris P. Gale, MBBS, PhD, MEd, MSc, from the University of Leeds in the United Kingdom, told Cardiology Advisor. “This is reflected in the fact that international guidelines differ in their recommendation and level of recommendation for the use of [beta-blockers] for patients with AMI who do not have heart failure.”

“Randomized trials of the use of [beta-blockers] for patients with AMI are historical, included patients with and without heart failure, and pre-dated the modern management of AMI,” Dr Gale added. “There are no contemporary randomized controlled trials testing the efficacy of [beta-blockers] among patients with AMI who do not have heart failure.”

Recent observational data do not suggest a survival benefit with beta-blocker use in patients with AMI without heart failure, although beta-blocker use lowered 30-day mortality in the FAST-MI (French Registry on Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction) observational study.^2,3 However, stopping beta-blocker treatment at 1 year in FAST-MI did not lead to an increase in 5-year mortality.³

Researchers, led by Dr Gale and Tatendashe B. Dondo, MSc, also from the University of Leeds, evaluated whether beta-blocker use affected all-cause mortality at 1 year in patients with AMI without heart failure or left ventricular systolic dysfunction (LVSD).¹

In a national registry, 179,810 patients were hospitalized with AMI without heart failure or LVSD and survived to discharge. Approximately 51% of patients had ST-segment elevation myocardial infarction (STEMI), and 49% had non-STEMI (NSTEMI). Of the total study population, 94.8% were treated with beta-blockers.¹

The overall mortality rate was 5.2% (n=9373). In the unadjusted analysis, 1-year mortality was lower in the beta-blocker group than in the no beta-blocker group (4.9% vs 11.2%; P <.001).¹

After adjusting for confounding factors, however, there was no difference in 1-year mortality between the groups. Similar findings were observed in patients with STEMI and NSTEMI.¹

“At the moment I would not recommend a change of practice. This study adds to the weight of evidence suggesting that [beta blockers] may not have a mortality benefit among patients with AMI who do not have heart failure,” Dr Gale said.

According to Dr Gale, a randomized clinical trial is needed and should evaluate additional outcomes including recurrent AMI, arrhythmia, and quality of life.

Disclosures

Dr Gale has received consulting and speaker honoraria from Novartis and AstraZeneca. 

References

1. Dondo TB, Hall M, West RM, et al. β-Blockers and mortality after acute myocardial infarction in patients without heart failure or ventricular dysfunction. Am Coll Cardiol. 2017;69(22):2710-2720. doi:10.1016/j.jacc.2017.03.578
2. Huang BT, Huang FY, Zuo ZL, et al. Meta-analysis of relation between oral β-blocker therapy and outcomes in patients with acute myocardial infarction who underwent percutaneous coronary intervention. Am J Cardiol.