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β blockers and mortality after myocardial infarction in patients without heart failure: multicentre prospective
Etienne Puymirat1, Elisabeth Riant2, Nadia Aissaoui3
1Department of Cardiology, Hôpital Européen Georges Pompidou, 75015 Paris, France Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris-Descartes, Paris, France etienne.puymirat@egp.aphp.fr.
Insights
Early beta blocker use significantly reduced 30-day mortality after acute myocardial infarction. However, prolonged beta blocker treatment beyond one year did not impact five-year survival in patients without heart failure.
Area of Science:
- Cardiology
- Clinical Medicine
- Pharmacology
Background:
- Beta blockers are commonly prescribed after acute myocardial infarction (AMI).
- The optimal duration of beta blocker therapy in patients without heart failure or left ventricular dysfunction post-AMI remains debated.
Purpose of the Study:
- To evaluate the association between early and prolonged beta blocker treatment and mortality following acute myocardial infarction.
- To assess the impact of beta blocker continuation versus discontinuation at one year on long-term survival.
Main Methods:
- A multicentre prospective cohort study involving 2679 patients from the French registry of Acute ST- and non-ST-elevation Myocardial Infarction (FAST-MI).
- Mortality was assessed at 30 days, one year, and five years post-AMI in relation to beta blocker use.
- Statistical analyses included adjusted hazard ratios, propensity score, and sensitivity analyses.
Main Results:
- Early beta blocker use (≤48 hours) was associated with significantly lower 30-day mortality (adjusted HR 0.46).
- Beta blocker prescription at discharge or persistence at one year was not significantly associated with reduced one-year or five-year mortality.
- Continued statin use at one year was associated with reduced five-year mortality (adjusted HR 0.42).
Conclusions:
- Early beta blocker administration is beneficial for reducing short-term mortality after AMI.
- Prolonged beta blocker treatment beyond one year may not offer survival benefits in patients without heart failure or left ventricular dysfunction.
- These findings suggest a re-evaluation of long-term beta blocker therapy guidelines in select post-MI populations.
Objective:
To assess the association between early and prolonged β blocker treatment and mortality after acute myocardial infarction.
Design:
Multicentre prospective cohort study.
Setting:
Nationwide French registry of Acute ST- and non-ST-elevation Myocardial Infarction (FAST-MI) (at 223 centres) at the end of 2005.
Participants:
2679 consecutive patients with acute myocardial infarction and without heart failure or left ventricular dysfunction.
Main Outcome Measures:
Mortality was assessed at 30 days in relation to early use of β blockers (≤48 hours of admission), at one year in relation to discharge prescription, and at five years in relation to one year use.
Results:
β blockers were used early in 77% (2050/2679) of patients, were prescribed at discharge in 80% (1783/2217), and were still being used in 89% (1230/1383) of those alive at one year. Thirty day mortality was lower in patients taking early β blockers (adjusted hazard ratio 0.46, 95% confidence interval 0.26 to 0.82), whereas the hazard ratio for one year mortality associated with β blockers at discharge was 0.77 (0.46 to 1.30). Persistence of β blockers at one year was not associated with lower five year mortality (hazard ratio 1.19, 0.65 to 2.18). In contrast, five year mortality was lower in patients continuing statins at one year (hazard ratio 0.42, 0.25 to 0.72) compared with those discontinuing statins. Propensity score and sensitivity analyses showed consistent results.
Conclusions:
Early β blocker use was associated with reduced 30 day mortality in patients with acute myocardial infarction, and discontinuation of β blockers at one year was not associated with higher five year mortality. These findings question the utility of prolonged β blocker treatment after acute myocardial infarction in patients without heart failure or left ventricular dysfunction.Trial registration Clinical trials NCT00673036.
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