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Outcomes in the BETAMI-DANBLOCK trial compared with a Norwegian nationwide myocardial infarction population

Anna Meta Dyrvig Kristensen1, Jarle Jortveit2, Therese Holmager1

  • 1Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen, Denmark.

European Heart Journal
|May 25, 2026
PubMed

Insights

Beta-blockers effectively reduce mortality risk in myocardial infarction (MI) patients without heart failure. This study confirms their consistent benefit, even when trial participants differ from a broader patient registry.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Public Health

Background:

  • The BETAMI-DANBLOCK trial demonstrated beta-blocker efficacy in myocardial infarction (MI) patients with preserved ejection fraction.
  • Representativeness of trial populations to real-world patients is crucial for treatment guideline applicability.

Purpose of the Study:

  • To assess the representativeness of the BETAMI-DANBLOCK trial population compared to a broader cohort of MI patients.
  • To evaluate the generalizability of beta-blocker treatment effects in MI patients with LVEF ≥ 40%.

Main Methods:

  • Comparison of baseline characteristics between BETAMI-DANBLOCK participants and the Norwegian Myocardial Infarction Registry (NORMI) cohort.
  • Estimation of absolute risks for all-cause mortality and MI at 3-year follow-up.
  • Transportability analysis using population weighting to adjust for cohort differences.

Main Results:

  • The NORMI cohort was older and had a higher prevalence of diabetes, prior coronary artery disease, and lower-normal ejection fraction (LVEF 40-49%) compared to trial participants.
  • Absolute 3-year risks of all-cause mortality or MI were higher in the NORMI cohort (12.0%) than in BETAMI (7.7%) and DANBLOCK (7.8%).
  • Beta-blocker treatment effects on mortality or MI remained consistent after weighting the trial population to match NORMI cohort characteristics.

Conclusions:

  • BETAMI-DANBLOCK participants represented a healthier subgroup compared to the general MI population in the NORMI registry.
  • Despite baseline differences, beta-blockers demonstrated consistent efficacy in reducing adverse cardiovascular events, supporting their use in MI patients with LVEF ≥ 40%.
Abstract

Keywords:
Acute myocardial infarctionBeta-blockerRandomized controlled trialRepresentativeness

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