Beta Blockers Reduce Mortality And Heart Failure In Mi Patients With Mildly Reduced Ejection Fraction

Beta-blocker therapy importantly reduced a composite endpoint of all-cause mortality, caller myocardial infarction (MI) and bosom nonaccomplishment (HF) compared pinch nary beta-blocker therapy successful nan subgroup of patients pinch MI and mildly reduced near ventricular ejection fraction (LVEF), according to an individual diligent information meta-analysis presented successful a Hot Line convention coming astatine ESC Congress 2025. The results person been simultaneously published successful The Lancet.

"Patients post-MI pinch mildly reduced LVEF (40−49%) but without HF correspond a sizeable population. While it is intuitive to reason that these patients use from beta-blockers successful a akin measurement arsenic patients pinch reduced LVEF (<40%), location person been nary circumstantial randomised trials. Four caller randomised tests tested assessed beta-blockers aft a caller MI successful patients pinch LVEF ≥40%; however, nary was individually powered to measure effects successful nan mildly reduced LVEF 40−49% subgroup," explained Doctor Xavier Rosselló from nan Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain and nan Son Espases University Hospital, Palma de Mallorca, Spain, speaking connected behalf of nan researches from nan 4 trials.

A systematic reappraisal was conducted of randomized controlled tests pinch beta-blockers performed successful nan reperfusion era (from 2000 onwards) pinch a median follow-up of much than 1 twelvemonth successful patients pinch a caller (within 14 days) MI (both ST-elevation MI aliases non-ST-elevation MI), mildly reduced LVEF and nary history aliases objective signs of HF. Four tests were identified: REBOOT conducted successful Spain and Italy, BETAMI successful Norway, DANBLOCK successful Denmark and CAPITAL-RCT successful Japan. Results from nan REBOOT trial and a mixed study of nan BETAMI and DANBLOCK trials were presented successful nan aforesaid Hot Line convention today, while CAPITAL-RCT was published successful 2018. In a prespecified, individual diligent level meta-analysis crossed nan 4 trials, a one-stage, fixed-effects attack was utilized to measure nan effect of beta-blockers connected nan pre-defined superior composite endpoint of all-cause death, caller MI aliases HF. All endpoints were independently adjudicated successful each 4 trials.

Overall, 1,885 patients pinch mildly reduced LVEF were analysed from nan 4 tests (979 patients from REBOOT, 422 from BETAMI, 430 from DANBLOCK and 54 from CAPITAL-RCT), making up 13.1% of nan study populations from nan main trials.

The superior endpoint occurred successful 10.7% of patients successful nan beta-blocker group and 14.4% of patients successful nan nary beta-blocker group, representing a important 25% comparative simplification pinch beta-blockers (hazard ratio [HR] 0.75; 95% assurance interval [CI] 0.58 to 0.97; p=0.031). There was nary evident heterogeneity successful nan effect connected nan superior endpoint betwixt nan 4 tests aliases betwixt nan countries of enrolment (Spain, Italy, Norway, Denmark and Japan).

The 3 individual components of nan superior endpoint followed nan aforesaid guidance arsenic nan composite endpoint. All-cause decease occurred successful 5.9% and 7.7% of patients successful nan beta-blocker and nary beta-blocker groups, respectively (HR 0.78; 95% CI 0.55 to 1.11). New MI occurred successful 3.9% and 5.2% of patients, respectively (HR 0.77; 95% CI 0.55 to 1.11), while HF occurred successful 3.0% and 4.4% of patients, respectively (HR 0.71; 95% CI 0.44 to 1.14). In addition, cardiac decease was recovered to hap successful 1.8% of patients connected beta-blockers and 3.3% of patients pinch nary beta-blockers (HR 0.55; 95% CI 0.28 to 1.06).

Our findings widen nan known benefits of these agents successful MI patients pinch reduced LVEF to nan subgroup pinch mildly reduced LVEF. Further investigation should now attraction connected patients pinch preserved LVEF (>50%)."

Doctor Xavier Rosselló, Centro Nacional de Investigaciones Cardiovasculares Carlos III