Determining major adverse cardiovascular event risk of beta-blocker discontinuation after acute coronary syndromes

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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

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Nicolas Johner1,2, Baris Gencer1,3,4

  • 1Cardiology Division, Geneva University Hospitals, Geneva, Switzerland.

Expert Review of Cardiovascular Therapy
|June 16, 2025
PubMed

Insights

Routine beta-blocker use after acute coronary syndromes (ACS) may be unnecessary for patients with preserved ejection fraction (≥50%). Individualized treatment decisions are recommended, weighing risks and benefits of deprescribing beta-blockers.

Area of Science:

  • Cardiology
  • Clinical Pharmacology
  • Evidence-Based Medicine

Background:

  • Beta-blockers historically reduced mortality post-acute coronary syndromes (ACS) before reperfusion therapies.
  • Contemporary ACS management with early reperfusion and secondary prevention has shifted the benefit-risk profile of beta-blockers.
  • The role of beta-blockers in ACS patients with preserved left ventricular ejection fraction (LVEF) is increasingly questioned.

Purpose of the Study:

  • To review contemporary evidence on beta-blocker efficacy in ACS patients with preserved LVEF.
  • To evaluate implications for different LVEF categories, ACS subtypes, and treatment durations.
  • To provide expert opinion on individualizing beta-blocker therapy post-ACS.

Main Methods:

  • Systematic review of PubMed database (inception to January 2025).
  • Analysis of recent randomized trials (REDUCE-AMI, ABYSS) and contemporary observational data.
  • Assessment of factors influencing beta-blocker prescription and discontinuation.

Main Results:

  • Sufficient evidence suggests abandoning routine beta-blocker prescription for post-ACS patients with LVEF ≥50%.
  • Individualized decision-making is crucial, balancing cardiovascular event risk against deprescribing benefits.
  • Factors like adverse effects, polypharmacy, and long-term stability favor discontinuation.

Conclusions:

  • Routine beta-blocker use is not recommended for post-ACS patients with LVEF ≥50%.
  • Personalized treatment strategies should consider patient-specific factors, LVEF, and tolerance.
  • Beta-blockers remain indicated for specific conditions like LVEF ≤40%, arrhythmias, angina, and refractory hypertension.
Abstract

Keywords:
Beta-blockerNSTEMISTEMIacute coronary syndromemildly reduced ejection fractionmyocardial infarctionpreserved ejection fractionsecondary prevention

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