Comparison of Outcomes of Beta-Blocker Therapy after Acute Myocardial Infarction in Patients without Heart Failure or Left Ventricular Systolic Dysfunction (From the Acute Coronary Syndromes Israeli Survey [ACSIS]).
The contemporary benefit of routine beta-blocker therapy following myocardial infraction in the absence of heart failure or left ventricular systolic dysfunction (LVSD) is unclear. We investigated the impact of beta-blockers on post myocardial infarction outcome in patients without heart failure or LVSD among patients enrolled in the biennial Acute Coronary Syndrome Israeli Surveys (ACSIS). MACE rates at 30 days and overall mortality at one year were compared among patients discharged on beta-blockers vs. not, after multivariate analysis to adjust for baseline differences. Between the years 2000-2016, data from 15.211consecutive ACS patients were collected. Of 7392 patients who met the inclusion criteria, 6007 (79.9%) were discharged on beta-blocker therapy. Prescription of beta-blockers at discharge increased modestly from 32% to 38% over the 16-year period. The 30-day MACE rates were similar in patients on vs. not on beta-blockers at discharge (9.0% and 9.5%, respectively). One year survival did not differ significantly between those on vs. not on beta-blockers (HR 0.8, 95% CI 0.58-1.11, P= 0.18).In conclusion, beta-blocker therapy did not affect 30 days MACE or one-year survival after myocardial infarction in patients without heart failure or reduced ejection fraction.