Beta-blocker prescription and outcomes in uncomplicated acute myocardial infarction: Insight from the ePARIS registry
Gaspard Suc1, Michel Zeitouni1, Niki Procopi1
1Sorbonne Université, ACTION Study Group, Inserm UMRS 1166, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
Insights
Beta-blockers are less prescribed in patients with uncomplicated myocardial infarction, despite their low mortality risk. Further research is needed to confirm long-term beta-blocker benefits in these low-risk patients.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- Beta-blocker prescription post-myocardial infarction (MI) is debated, particularly for uncomplicated cases.
- Revascularization strategies impact post-MI care, raising questions about optimal medical therapy.
Purpose of the Study:
- To assess beta-blocker use in real-world patients with uncomplicated ST-segment elevation myocardial infarction (STEMI).
- To analyze characteristics and outcomes of patients with uncomplicated MI.
- To determine the proportion of patients with preserved left ventricular ejection fraction and no early cardiovascular events.
Main Methods:
- Analysis of 1887 consecutive STEMI patients from the prospective ePARIS registry.
- Classification into three groups: uncomplicated MI (LVEF ≥40%, no events), complicated MI (LVEF ≥40%, recurrent events), and left ventricular dysfunction (LVEF <40%).
- Median follow-up of 2.7 years.
Main Results:
- Uncomplicated MI patients showed significantly lower mortality risk compared to complicated MI and LV dysfunction groups (HR 0.38 and 0.22, respectively).
- Beta-blocker prescription rates at discharge were high: 93% in uncomplicated MI, 87% in complicated MI, and 81% in LV dysfunction.
- Despite high prescription rates in low-risk patients, the study questions the long-term benefit.
Conclusions:
- Beta-blockers are frequently prescribed to low-risk patients with uncomplicated MI.
- Current evidence may not fully support the long-term benefit of beta-blockers in patients without LV dysfunction or recurrent events beyond 6 months.
- Further studies are needed to clarify the role of beta-blockers in specific post-MI patient subgroups.
Background:
Systematic prescription of beta-blockers after myocardial infarction remains an open question in the era of revascularization, especially for patients with uncomplicated myocardial infarction.
Objective:
To evaluate in a real-life registry the proportion of patients with uncomplicated myocardial infarction (preserved left ventricular ejection fraction and no cardiovascular event within the first 6 months), and to report their characteristics, outcomes and beta-blocker use.
Methods:
We included 1887 consecutive patients with ST-segment elevation myocardial infarction from the prospective ePARIS registry. Patients were divided into three groups: the "uncomplicated myocardial infarction" group (n=1060), defined by a left ventricular ejection fraction ≥ 40% and a 6-month period free from cardiovascular events; the "complicated myocardial infarction" group (n=366), defined by a left ventricular ejection fraction ≥ 40% and a recurrent cardiovascular event in the first 6 months; and the "left ventricular dysfunction" group (n=461), defined by a left ventricular ejection fraction<40%.
Results:
During a median follow-up of 2.7 years (interquartile range 1.0-4.9 years), the "uncomplicated myocardial infarction" group was at low mortality risk compared with the "complicated myocardial infarction" group (hazard ratio 0.38, 95% confidence interval 0.25-0.58; P<0.01) and the "left ventricular dysfunction" group (hazard ratio 0.22, 95% confidence interval 0.15-0.32; P<0.01). Beta-blockers were prescribed at discharge predominantly in the "uncomplicated myocardial infarction" group (93%) compared with 87% in the "complicated myocardial infarction" group and 81% in the "left ventricular dysfunction" group.
Conclusions:
Beta-blockers are less prescribed in patients who may need them the most. The benefit of beta-blockers-largely prescribed in lower-risk patients-remains to be shown beyond the first 6 months for these patients with no left ventricular dysfunction and no recurrent events.
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