Related Experiment Video
Updated: Jun 14, 2025
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
Continuation vs Withdrawal of Beta-Blockers and Outcomes After Myocardial Infarction With Preserved Left Ventricular
Michael H Chiu1, Yuan Dong2, Nowell Fine3
1Libin Cardiovascular Institute, Department of Cardiac Sciences University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.
Insights
Discontinuing beta-blockers early after acute myocardial infarction (AMI) in patients with preserved ejection fraction did not increase composite outcomes. However, early beta-blocker cessation was linked to higher risks of recurrent AMI and repeat revascularization.
Area of Science:
- Cardiology
- Clinical Research
- Pharmacology
Background:
- The established role of beta-blocker (BB) therapy post-acute myocardial infarction (AMI) with contemporary treatments requires further clarification.
- Investigating the impact of early BB discontinuation on patient outcomes is crucial for refining post-AMI care guidelines.
Purpose of the Study:
- To assess the association between early beta-blocker (BB) discontinuation and clinical outcomes in patients following an acute myocardial infarction (AMI).
- This retrospective cohort study evaluated if stopping BB prescriptions within 180 days of discharge impacts major adverse cardiovascular events.
Main Methods:
- A retrospective cohort study analyzed linked registry and administrative data from 2008-2017.
- Included patients survived ≥180 days post-AMI, had a new BB prescription, and preserved left ventricular ejection fraction (LVEF) ≥50%.
- Cox proportional hazard models assessed the link between early BB discontinuation and a composite of recurrent AMI, revascularization, or mortality within 5 years.
Main Results:
- Of 4,768 patients, 24.2% discontinued BBs within 180 days.
- Early BB discontinuation was not significantly associated with the composite outcome (HR: 1.09) or all-cause mortality (HR: 1.04).
- However, early BB cessation correlated with increased risks of recurrent AMI and repeat myocardial revascularization.
Conclusions:
- In AMI patients with preserved LVEF, early BB discontinuation (≤180 days) did not elevate the risk of a composite outcome including death, recurrent AMI, or revascularization.
- Early BB cessation was, however, associated with a higher incidence of recurrent AMI and the need for repeat revascularization procedures.
Background:
The role of routine beta-blocker (BB) use after uncomplicated acute myocardial infarction (AMI) treated with contemporary therapies is not well established.
Objectives:
The authors conducted a retrospective cohort study using linked registry and administrative data to evaluate whether early BB discontinuation (a prescription ending within 180 days of discharge) is associated with clinical outcomes.
Methods:
We included patients who survived at least 180 days after AMI from 2008 to 2017 with new BB prescription and left ventricular ejection fraction ≥50%. The primary outcome was a composite of recurrent AMI, myocardial revascularization, or all-cause mortality within 5 years. Secondary outcomes were each of the components of the composite. Cox proportional hazard models were used to evaluate the association between early BB discontinuation and outcomes.
Results:
Among the 4,768 included patients, 1,155 (24.2%) discontinued BB within 180 days of AMI discharge. During a median follow-up time of 57 months, 964 patients (20.2%) experienced the primary outcome. Early BB discontinuation was not associated with an increased risk of the primary outcome (adjusted HR: 1.09; 95% CI: 0.94-1.26), or with all-cause mortality (HR: 1.04; 95% CI: 0.86-1.26). However, early BB discontinuation was associated with an increased risk for recurrent AMI and a higher rate of repeat revascularization.
Conclusions:
In patients with preserved left ventricular ejection fraction after AMI, discontinuation of BB within 180 days was not associated with a significantly increased risk of a composite outcome of death, recurrent AMI, or revascularization but was associated with increased risk of recurrent AMI and need for repeat revascularization.
More Related Videos
Related Concept Videos
01:22Heart Failure Drugs: β-Blockers
01:31Adrenergic Antagonists: ɑ and β-Receptor Blockers
01:27Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers
01:24Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers
01:28Antihypertensive Drugs: Types of β-Blockers
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System