Long-term β-blocker therapy and clinical outcomes after acute myocardial infarction in patients without heart...

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Acute myocardial infarction (AMI) is a leading cause of cardiovascular mortality.
• Beta-blockers are standard therapy post-AMI, but optimal duration in patients without heart failure (HF) remains debated.
• Understanding long-term outcomes associated with beta-blocker therapy is crucial for treatment guidelines.

Purpose of the Study:

• To evaluate the association between long-term beta-blocker therapy and clinical outcomes in patients surviving AMI without developing HF.
• To compare outcomes between patients receiving beta-blocker therapy for at least one year versus less than one year post-AMI.

Main Methods:

• A nationwide cohort study utilizing Korean medical insurance data from 2010-2015.
• Included 28,970 patients who underwent revascularization for AMI, were prescribed beta-blockers at discharge, and were event-free for one year.
• Landmark analysis at one year compared outcomes between beta-blocker therapy for ≥1 year (n=22,707) and <1 year (n=6,263).

Main Results:

• Long-term beta-blocker therapy (≥1 year) was associated with a significantly lower risk of all-cause death (adjusted HR 0.81; 95% CI 0.72-0.91).
• A composite outcome of death, recurrent MI, or HF hospitalization was also reduced with long-term therapy (adjusted HR 0.82; 95% CI 0.75-0.89).
• No significant difference was observed in risks of recurrent MI or HF hospitalization alone between the groups.

Conclusions:

• Continuous beta-blocker therapy for at least one year following AMI, in patients without heart failure, is associated with improved survival.
• The survival benefit of persistent beta-blocker use was evident beyond two years post-MI but not consistently beyond three years.
• These findings support the use of long-term beta-blocker therapy in select AMI patients to reduce mortality.