Beta-blocker prescription and outcomes in uncomplicated acute myocardial infarction: Insight from the ePARIS registry - 05/02/23
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Highlights |
• | Beta-blocker efficiency in reducing mortality after MI is well established. |
• | This efficiency was demonstrated before the reperfusion therapy era. |
• | Uncomplicated MI has a low risk of subsequent mortality and cardiovascular events. |
• | It is easily identified by LVEF ≥ 40% and absence of recurrent events at 6 months. |
• | Patients with uncomplicated MI seem ideal candidates for beta-blocker withdrawal. |
• | This hypothesis was tested in the randomized AβYSS trial. |
Abstract |
Background |
Systematic prescription of beta-blockers after myocardial infarction remains an open question in the era of revascularization, especially for patients with uncomplicated myocardial infarction.
Objective |
To evaluate in a real-life registry the proportion of patients with uncomplicated myocardial infarction (preserved left ventricular ejection fraction and no cardiovascular event within the first 6 months), and to report their characteristics, outcomes and beta-blocker use.
Methods |
We included 1887 consecutive patients with ST-segment elevation myocardial infarction from the prospective ePARIS registry. Patients were divided into three groups: the “uncomplicated myocardial infarction” group (n=1060), defined by a left ventricular ejection fraction ≥ 40% and a 6-month period free from cardiovascular events; the “complicated myocardial infarction” group (n=366), defined by a left ventricular ejection fraction ≥ 40% and a recurrent cardiovascular event in the first 6 months; and the “left ventricular dysfunction” group (n=461), defined by a left ventricular ejection fraction<40%.
Results |
During a median follow-up of 2.7 years (interquartile range 1.0–4.9 years), the “uncomplicated myocardial infarction” group was at low mortality risk compared with the “complicated myocardial infarction” group (hazard ratio 0.38, 95% confidence interval 0.25–0.58; P<0.01) and the “left ventricular dysfunction” group (hazard ratio 0.22, 95% confidence interval 0.15–0.32; P<0.01). Beta-blockers were prescribed at discharge predominantly in the “uncomplicated myocardial infarction” group (93%) compared with 87% in the “complicated myocardial infarction” group and 81% in the “left ventricular dysfunction” group.
Conclusions |
Beta-blockers are less prescribed in patients who may need them the most. The benefit of beta-blockers–largely prescribed in lower-risk patients–remains to be shown beyond the first 6 months for these patients with no left ventricular dysfunction and no recurrent events.
Le texte complet de cet article est disponible en PDF.Keywords : Beta-blocker, Myocardial infarction, Coronary intervention
Abbreviations : AβYSS, CI, HR, LV, LVEF, MACE, MI, PCI
Plan
Vol 116 - N° 1
P. 25-32 - janvier 2023 Retour au numéro
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