Beta-blocker therapy after acute coronary syndrome in patients without heart failure or reduced ejection fraction: A
V De Sio1,2, F Gragnano1,2, A Cesaro1,2
1Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Caserta, Italy.
Insights
Beta-blocker therapy in acute coronary syndrome (ACS) patients without heart failure (HF) or reduced ejection fraction did not significantly lower the risk of death or myocardial infarction (MI) at one year. This finding challenges routine use in this specific ACS population.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- Beta-blockers are standard therapy for acute coronary syndromes (ACS).
- Their benefit in ACS patients without chronic heart failure (HF) or left ventricular ejection fraction (LVEF) <40% is uncertain.
- This study investigates beta-blocker use in a contemporary ACS cohort.
Purpose of the Study:
- To evaluate the association between beta-blocker therapy and clinical outcomes in ACS patients without HF or LVEF <40%.
- To assess the 1-year risk of all-cause death or myocardial infarction (MI) in this patient group.
Main Methods:
- Analysis of the START-ANTIPLATELET registry, excluding patients with HF or LVEF <40%.
- Stratification based on beta-blocker use at discharge.
- Utilized target trial emulation and inverse probability of treatment weighting (IPTW).
- Primary endpoint: composite of all-cause death or MI at 1 year.
Main Results:
- 1,315 ACS patients without HF or LVEF <40% were included; 72.2% received beta-blockers.
- No significant association between beta-blocker use and the primary endpoint (IPTW-adjusted HR 0.66; p=0.249).
- Exploratory analysis suggested a potential benefit in ST-segment elevation MI, but this was not consistently reproduced.
Conclusions:
- Beta-blocker therapy is common in ACS patients without HF or LVEF <40%.
- In this real-world cohort, beta-blockers were not associated with a reduced 1-year risk of death or MI.
- Findings suggest a need to re-evaluate beta-blocker use in this specific ACS subgroup.
Aims:
The benefits of β-blockers in patients with acute coronary syndromes (ACS) without chronic heart failure (HF) or left ventricular ejection fraction (LVEF) < 40% remain uncertain. We evaluated the association between β-blocker therapy and clinical outcomes in a multicenter, contemporary ACS registry.
Methods:
In the START-ANTIPLATELET registry (NCT02219984), patients were excluded if they had HF or LVEF <40%. Participants were stratified according to β-blocker use at discharge after ACS. A target trial emulation and inverse probability of treatment weighting (IPTW) were used. The primary endpoint was a composite of all-cause death or myocardial infarction (MI) at 1 year.
Results:
The primary analysis included 1,315 patients with ACS without HF or LVEF <40%, of whom 949 (72.2%) were discharged on β-blockers. At 1 year, the primary endpoint occurred in 21 (2.2%) patients receiving β-blockers versus 13 (3.6%) without β-blockers, and no significant association was observed (unweighted HR 0.63, 95% CI 0.31-1.26; p = 0.192; IPTW-adjusted HR 0.66, 95% CI 0.33-1.33; p = 0.249). Exploratory subgroup analyses suggested a potentially more favourable association of β-blocker therapy in patients with ST-segment elevation MI (p-interaction=0.049), although this finding was not uniformly reproduced across sensitivity analyses.
Conclusions:
In a contemporary real-world cohort of ACS patients without HF or LVEF <40%, β-blocker therapy was prescribed in approximately 70% of patients and was not associated with a lower 1-year risk of death or MI.
Related Concept Videos
01:22Heart Failure Drugs: β-Blockers
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:31Adrenergic Antagonists: ɑ and β-Receptor Blockers
01:27Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies