Clinical Outcomes With Beta-Blocker Use in Patients With Recent History of Myocardial Infarction
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Updated: Dec 21, 2025
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
Cynthia A Jackevicius1, Harlan M Krumholz2, Joseph S Ross3
1Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, California, USA; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada.
Insights
Beta-blockers (BBs) did not reduce major cardiovascular events or mortality in stable patients with recent myocardial infarction (MI). This study highlights the need for new clinical trials on BB effectiveness after MI.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- Uncertainty exists regarding the benefits of beta-blockers (BBs) in stable patients with a history of myocardial infarction (MI).
- Contemporary evidence is needed to guide BB use in this specific patient population.
Purpose of the Study:
- To examine the effectiveness of beta-blockers (BBs) in older, stable patients who have experienced a recent myocardial infarction (MI).
Main Methods:
- A cohort study utilized administrative databases for patients aged 65+ with MI within 3 years prior.
- Inverse probability of treatment weighting was applied to assess the primary outcome: time to death or hospitalization for MI/angina within 1 year.
Main Results:
- No significant difference in the 1-year hazard of death/hospitalization for MI or angina was observed between patients receiving BBs and those not (HR 1.00, 95% CI 0.94-1.07).
- Subgroup analyses across various patient characteristics, including age, sex, and comorbidities, did not reveal any benefit from BB use.
- A potential benefit was noted in patients with a history of revascularization at 1 year, but not at 3 years.
Conclusions:
- In a large, contemporary population of older, stable patients with recent MI, BBs were not associated with reduced cardiovascular events or mortality.
- These findings underscore the necessity for contemporary clinical trials to definitively evaluate beta-blocker efficacy after myocardial infarction.
Background:
It is uncertain whether beta-blockers (BBs) are beneficial in contemporary stable patients with prior myocardial infarction (MI). Therefore, we sought to examine the effectiveness of BB use in this population.
Methods:
We conducted a cohort study with the use of administrative databases of patients ≥ 65 years of age, alive on April 1, 2012 (index date) with a hospital discharge diagnosis of MI within the previous 3 years. The primary outcome was time to death or hospitalization for MI or angina 1 year after the index date, with inverse probability of treatment weighting.
Results:
We included 33,811 patients with prior MI, of whom 21,440 (63.4%) were dispensed a BB. The median age was 78 years, and 56% were male. There was no difference in the 1-year hazard of death/hospitalization for MI or angina (14.8% vs 14.7%, hazard ratio 1.00, 95% confidence interval 0.94-1.07; P = 0.90) in those receiving vs not receiving BB. Similarly, there was no difference in the individual end points in composite nor in 3-year outcomes. Subgroup analysis by age, sex, MI timing, MI type, heart failure, and atrial fibrillation found no benefit. Patients with a history of revascularisation treated with BBs had a lower rate of the composite outcome compared with those without such history (P = 0.006 for interaction) at 1 year but not at 3 years.
Conclusions:
In this large contemporary population-based observational study of older stable patients with prior MI, BBs were not associated with a reduction in major cardiovascular events or mortality in those with MI within the previous 3 years. This study supports the need to conduct contemporary clinical trials evaluating the use of BBs after MI.
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