Related Experiment Video

Updated: Sep 9, 2025

Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
14:35

Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs

Published on: April 17, 2021

8.6K

β blockers after myocardial infarction with mildly reduced ejection fraction: an individual patient data

Xavier Rossello1, Eva Irene Bossano Prescott2, Anna Meta Dyrvig Kristensen2

  • 1Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Cardiology Department, University Hospital Son Espases, Instituto de Investigación Sanitaria Islas Baleares and Universitat de les Illes Balears, Palma de Mallorca, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain.

Lancet (London, England)
|September 2, 2025
PubMed

Insights

Beta-blocker therapy significantly reduced composite endpoints of death, myocardial infarction, or heart failure in patients with myocardial infarction and mildly reduced left ventricular ejection fraction (LVEF). This extends known benefits to this understudied patient group.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Meta-Analysis

Background:

  • Clinical outcomes of beta-blocker therapy in myocardial infarction patients with mildly reduced left ventricular ejection fraction (LVEF) (40-49%) are not well-established.
  • Previous randomized trials focused on patients with LVEF ≥40% or did not have sufficient power for the mildly reduced LVEF subgroup.

Purpose of the Study:

  • To assess the efficacy of beta-blocker therapy in patients experiencing myocardial infarction with mildly reduced LVEF during index hospitalization.

Main Methods:

  • Individual patient-level meta-analysis of four randomized controlled trials involving patients with mildly reduced LVEF and no heart failure history/signs.
  • Utilized a one-stage, fixed-effects, Cox proportional hazards regression model for analysis.
  • Primary composite endpoint: all-cause death, new myocardial infarction, or heart failure, with independent adjudication.

Main Results:

  • Included 1885 patients (991 on beta-blockers, 894 on control).
  • Beta-blocker group showed a reduced composite endpoint (32.6 events/1000 patient-years) compared to the control group (43.0 events/1000 patient-years).
  • Hazard ratio was 0.75 (95% CI 0.58-0.97; p=0.031), with no significant heterogeneity observed between trials or countries.

Conclusions:

  • Beta-blocker therapy is associated with a significant reduction in adverse composite outcomes for patients with acute myocardial infarction and mildly reduced LVEF.
  • These findings expand the established benefits of beta-blockers post-myocardial infarction to include patients with mildly reduced LVEF.
Abstract

More Related Videos

Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction05:26

Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction

Published on: May 28, 2019

9.4K
Protection of H9c2 Myocardial Cells from Oxidative Stress by Crocetin via PINK1/Parkin Pathway-Mediated Mitophagy07:40

Protection of H9c2 Myocardial Cells from Oxidative Stress by Crocetin via PINK1/Parkin Pathway-Mediated Mitophagy

Published on: May 26, 2023

1.3K

Related Concept Videos

Heart Failure Drugs: β-Blockers01:22

Heart Failure Drugs: β-Blockers

β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
434
Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers01:27

Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers

β-receptor blockers significantly impact the cardiovascular system by counteracting catecholamine-induced sympathetic responses. These medications decrease heart rate, contractility, and cardiac output, potentially leading to cardiac depression, life-threatening bradycardia, and death. Therapeutically, β-blockers function as mild antihypertensives and are utilized in treating angina pectoris and cardiac arrhythmias. However, nonselective β-blockers inhibit β2-receptors in...
970
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
505
Antianginal Drugs: Nitrates and β-Blockers01:16

Antianginal Drugs: Nitrates and β-Blockers

In cardiovascular health, antianginal drugs combat angina pectoris — a condition marked by chest pain owing to diminished blood flow to the heart.
Organic nitrates,  such as nitroglycerin, play a pivotal role. Once metabolized, they liberate nitric oxide, a molecular marvel. Nitric oxide triggers guanylyl cyclase and augments cGMP production. This biochemical cascade orchestrates the relaxation of vascular smooth muscles, ushering in vasodilation and enhancing coronary blood flow....
749
Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers01:24

Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers

Adrenergic stimulation generally impacts cardiac rate and rhythm. Specifically, stimulation of the β-adrenoceptors triggers an increase in intracellular calcium ion influx and pacemaker currents, which may cause arrhythmias. Catecholamines like adrenaline also demonstrate β2-adrenoceptor-mediated hypokalemia, impacting cardiac action potential and disrupting the normal cardiac rhythm. Class II antiarrhythmic drugs are β-adrenoceptor antagonists or β-blockers, which...
845
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
23