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Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction

Yndigegn, Troels LU ; Lindahl, Bertil ; Mars, Katarina ; Alfredsson, Joakim ; Benatar, Jocelyne ; Brandin, Lisa ; Erlinge, David LU orcid ; Hallen, Ola ; Held, Claes and Hjalmarsson, Patrik , et al. (2024) In The New England journal of medicine 390(15). p.1372-1381
Abstract

BACKGROUND: Most trials that have shown a benefit of beta-blocker treatment after myocardial infarction included patients with large myocardial infarctions and were conducted in an era before modern biomarker-based diagnosis of myocardial infarction and treatment with percutaneous coronary intervention, antithrombotic agents, high-intensity statins, and renin-angiotensin-aldosterone system antagonists.

METHODS: In a parallel-group, open-label trial performed at 45 centers in Sweden, Estonia, and New Zealand, we randomly assigned patients with an acute myocardial infarction who had undergone coronary angiography and had a left ventricular ejection fraction of at least 50% to receive either long-term treatment with a beta-blocker... (More)

BACKGROUND: Most trials that have shown a benefit of beta-blocker treatment after myocardial infarction included patients with large myocardial infarctions and were conducted in an era before modern biomarker-based diagnosis of myocardial infarction and treatment with percutaneous coronary intervention, antithrombotic agents, high-intensity statins, and renin-angiotensin-aldosterone system antagonists.

METHODS: In a parallel-group, open-label trial performed at 45 centers in Sweden, Estonia, and New Zealand, we randomly assigned patients with an acute myocardial infarction who had undergone coronary angiography and had a left ventricular ejection fraction of at least 50% to receive either long-term treatment with a beta-blocker (metoprolol or bisoprolol) or no beta-blocker treatment. The primary end point was a composite of death from any cause or new myocardial infarction.

RESULTS: From September 2017 through May 2023, a total of 5020 patients were enrolled (95.4% of whom were from Sweden). The median follow-up was 3.5 years (interquartile range, 2.2 to 4.7). A primary end-point event occurred in 199 of 2508 patients (7.9%) in the beta-blocker group and in 208 of 2512 patients (8.3%) in the no-beta-blocker group (hazard ratio, 0.96; 95% confidence interval, 0.79 to 1.16; P = 0.64). Beta-blocker treatment did not appear to lead to a lower cumulative incidence of the secondary end points (death from any cause, 3.9% in the beta-blocker group and 4.1% in the no-beta-blocker group; death from cardiovascular causes, 1.5% and 1.3%, respectively; myocardial infarction, 4.5% and 4.7%; hospitalization for atrial fibrillation, 1.1% and 1.4%; and hospitalization for heart failure, 0.8% and 0.9%). With regard to safety end points, hospitalization for bradycardia, second- or third-degree atrioventricular block, hypotension, syncope, or implantation of a pacemaker occurred in 3.4% of the patients in the beta-blocker group and in 3.2% of those in the no-beta-blocker group; hospitalization for asthma or chronic obstructive pulmonary disease in 0.6% and 0.6%, respectively; and hospitalization for stroke in 1.4% and 1.8%.

CONCLUSIONS: Among patients with acute myocardial infarction who underwent early coronary angiography and had a preserved left ventricular ejection fraction (≥50%), long-term beta-blocker treatment did not lead to a lower risk of the composite primary end point of death from any cause or new myocardial infarction than no beta-blocker use. (Funded by the Swedish Research Council and others; REDUCE-AMI ClinicalTrials.gov number, NCT03278509.).

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publication status
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keywords
Humans, Adrenergic beta-Antagonists/adverse effects, Bisoprolol/adverse effects, Heart Failure/etiology, Myocardial Infarction/complications, Stroke Volume, Treatment Outcome, Ventricular Function, Left, Metoprolol/adverse effects, Secondary Prevention
in
The New England journal of medicine
volume
390
issue
15
pages
1372 - 1381
publisher
Massachussetts Medical Society
external identifiers
  • scopus:85190902711
  • pmid:38587241
ISSN
0028-4793
DOI
10.1056/NEJMoa2401479
language
English
LU publication?
yes
additional info
Copyright © 2024 Massachusetts Medical Society.
id
0f2b0a2b-1e9a-4a6f-9226-fa9a8fa451cc
date added to LUP
2024-10-18 12:56:45
date last changed
2025-06-01 09:56:03
@article{0f2b0a2b-1e9a-4a6f-9226-fa9a8fa451cc,
  abstract     = {{<p>BACKGROUND: Most trials that have shown a benefit of beta-blocker treatment after myocardial infarction included patients with large myocardial infarctions and were conducted in an era before modern biomarker-based diagnosis of myocardial infarction and treatment with percutaneous coronary intervention, antithrombotic agents, high-intensity statins, and renin-angiotensin-aldosterone system antagonists.</p><p>METHODS: In a parallel-group, open-label trial performed at 45 centers in Sweden, Estonia, and New Zealand, we randomly assigned patients with an acute myocardial infarction who had undergone coronary angiography and had a left ventricular ejection fraction of at least 50% to receive either long-term treatment with a beta-blocker (metoprolol or bisoprolol) or no beta-blocker treatment. The primary end point was a composite of death from any cause or new myocardial infarction.</p><p>RESULTS: From September 2017 through May 2023, a total of 5020 patients were enrolled (95.4% of whom were from Sweden). The median follow-up was 3.5 years (interquartile range, 2.2 to 4.7). A primary end-point event occurred in 199 of 2508 patients (7.9%) in the beta-blocker group and in 208 of 2512 patients (8.3%) in the no-beta-blocker group (hazard ratio, 0.96; 95% confidence interval, 0.79 to 1.16; P = 0.64). Beta-blocker treatment did not appear to lead to a lower cumulative incidence of the secondary end points (death from any cause, 3.9% in the beta-blocker group and 4.1% in the no-beta-blocker group; death from cardiovascular causes, 1.5% and 1.3%, respectively; myocardial infarction, 4.5% and 4.7%; hospitalization for atrial fibrillation, 1.1% and 1.4%; and hospitalization for heart failure, 0.8% and 0.9%). With regard to safety end points, hospitalization for bradycardia, second- or third-degree atrioventricular block, hypotension, syncope, or implantation of a pacemaker occurred in 3.4% of the patients in the beta-blocker group and in 3.2% of those in the no-beta-blocker group; hospitalization for asthma or chronic obstructive pulmonary disease in 0.6% and 0.6%, respectively; and hospitalization for stroke in 1.4% and 1.8%.</p><p>CONCLUSIONS: Among patients with acute myocardial infarction who underwent early coronary angiography and had a preserved left ventricular ejection fraction (≥50%), long-term beta-blocker treatment did not lead to a lower risk of the composite primary end point of death from any cause or new myocardial infarction than no beta-blocker use. (Funded by the Swedish Research Council and others; REDUCE-AMI ClinicalTrials.gov number, NCT03278509.).</p>}},
  author       = {{Yndigegn, Troels and Lindahl, Bertil and Mars, Katarina and Alfredsson, Joakim and Benatar, Jocelyne and Brandin, Lisa and Erlinge, David and Hallen, Ola and Held, Claes and Hjalmarsson, Patrik and Johansson, Pelle and Karlström, Patric and Kellerth, Thomas and Marandi, Toomas and Ravn-Fischer, Annica and Sundström, Johan and Östlund, Ollie and Hofmann, Robin and Jernberg, Tomas}},
  issn         = {{0028-4793}},
  keywords     = {{Humans; Adrenergic beta-Antagonists/adverse effects; Bisoprolol/adverse effects; Heart Failure/etiology; Myocardial Infarction/complications; Stroke Volume; Treatment Outcome; Ventricular Function, Left; Metoprolol/adverse effects; Secondary Prevention}},
  language     = {{eng}},
  month        = {{04}},
  number       = {{15}},
  pages        = {{1372--1381}},
  publisher    = {{Massachussetts Medical Society}},
  series       = {{The New England journal of medicine}},
  title        = {{Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction}},
  url          = {{http://dx.doi.org/10.1056/NEJMoa2401479}},
  doi          = {{10.1056/NEJMoa2401479}},
  volume       = {{390}},
  year         = {{2024}},
}