TY - JOUR
T1 - Beta-Blockers after Myocardial Infarction in Patients without Heart Failure
AU - BETAMI–DANBLOCK Investigators
AU - Munkhaugen, John
AU - Kristensen, Anna Meta D
AU - Halvorsen, Sigrun
AU - Holmager, Therese
AU - Olsen, Michael Hecht
AU - Bakken, Arnhild
AU - Sehested, Thomas S G
AU - Ruddox, Vidar
AU - Mæng, Michael
AU - Vikenes, Kjell
AU - Jensen, Svend E
AU - Steigen, Terje
AU - Lambrechtsen, Jess
AU - Jortveit, Jarle
AU - Bovin, Ann
AU - Schirmer, Henrik
AU - Christiansen, Morten Krogh
AU - Wiseth, Rune
AU - Mikkelsen, Dennis
AU - Larsen, Alf Inge
AU - Kjærgaard, Camilla Lyngby
AU - Andresen, Kristoffer
AU - Gustafsson, Ida
AU - Tuseth, Vegard
AU - Larsen, Mogens Lytken
AU - Deeg, Peter Stefan
AU - Veien, Karsten
AU - Bøhmer, Ellen
AU - Bøtker, Hans Erik
AU - Brattrud, Anja Otrebska
AU - Brønnum-Schou, Jens
AU - Pettersen, Alf-Åge Reistad
AU - Bang, Lia Evi
AU - Øie, Erik
AU - Engstrøm, Thomas
AU - Borg, Eva Bostad
AU - Kristensen, Kjeld
AU - Nymo, Ståle Haugset
AU - Gislason, Gunnar
AU - Vethe, Nils Tore
AU - Abdulla, Jawdat Abdul Majid
AU - Dammen, Toril
AU - Mouridsen, Mette Rauhe
AU - Bendz, Bjørn
AU - Bertelsen, Mette Lykke Norgaard
AU - Hove, Jens Dahlgaard
AU - Schierbeck, Louise
AU - Snoer, Martin
AU - Davidsen, Cedric
AU - Zwisler, Ann-Dorthe
AU - Prescott, Eva
N1 - Copyright © 2025 Massachusetts Medical Society.
PY - 2025/8/30
Y1 - 2025/8/30
N2 - BACKGROUND: The evidence supporting beta-blocker therapy after myocardial infarction was established before the introduction of modern coronary reperfusion therapy and secondary prevention strategies.METHODS: In an open-label, randomized trial with blinded end-point evaluation, conducted in Denmark and Norway, we assigned patients who had had a myocardial infarction and who had a left ventricular ejection fraction of at least 40%, in a 1:1 ratio, to receive long-term beta-blocker therapy within 14 days after the event or no beta-blocker therapy. The primary end point was a composite of death from any cause or major adverse cardiovascular events (new myocardial infarction, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmias).RESULTS: A total of 5574 patients underwent randomization and were included in the main analyses - 2783 in the beta-blocker group and 2791 in the no-beta-blocker group. After a median follow-up of 3.5 years (interquartile range, 2.2 to 4.6), a primary end-point event had occurred in 394 patients (14.2%) in the beta-blocker group and in 454 patients (16.3%) in the no-beta-blocker group (hazard ratio, 0.85; 95% confidence interval [CI], 0.75 to 0.98; P = 0.03). Death from any cause occurred in 4.2% of the patients in the beta-blocker group and in 4.4% of those in the no-beta-blocker group; myocardial infarction occurred in 5.0% and 6.7%, respectively (hazard ratio, 0.73; 95% CI, 0.59 to 0.92), unplanned coronary revascularization in 3.9% and 3.9%, ischemic stroke in 1.6% and 1.3%, heart failure in 1.5% and 1.9%, and malignant ventricular arrhythmias in 0.5% and 0.6%. No apparent differences in safety outcomes were observed between the groups.CONCLUSIONS: Among patients with a myocardial infarction and a left ventricular ejection fraction of at least 40%, beta-blocker therapy led to a lower risk of death or major adverse cardiovascular events than no beta-blocker therapy. (Funded by the Health South-East research program in Norway and others; BETAMI-DANBLOCK ClinicalTrials.gov numbers, NCT03646357 and NCT03778554.).
AB - BACKGROUND: The evidence supporting beta-blocker therapy after myocardial infarction was established before the introduction of modern coronary reperfusion therapy and secondary prevention strategies.METHODS: In an open-label, randomized trial with blinded end-point evaluation, conducted in Denmark and Norway, we assigned patients who had had a myocardial infarction and who had a left ventricular ejection fraction of at least 40%, in a 1:1 ratio, to receive long-term beta-blocker therapy within 14 days after the event or no beta-blocker therapy. The primary end point was a composite of death from any cause or major adverse cardiovascular events (new myocardial infarction, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmias).RESULTS: A total of 5574 patients underwent randomization and were included in the main analyses - 2783 in the beta-blocker group and 2791 in the no-beta-blocker group. After a median follow-up of 3.5 years (interquartile range, 2.2 to 4.6), a primary end-point event had occurred in 394 patients (14.2%) in the beta-blocker group and in 454 patients (16.3%) in the no-beta-blocker group (hazard ratio, 0.85; 95% confidence interval [CI], 0.75 to 0.98; P = 0.03). Death from any cause occurred in 4.2% of the patients in the beta-blocker group and in 4.4% of those in the no-beta-blocker group; myocardial infarction occurred in 5.0% and 6.7%, respectively (hazard ratio, 0.73; 95% CI, 0.59 to 0.92), unplanned coronary revascularization in 3.9% and 3.9%, ischemic stroke in 1.6% and 1.3%, heart failure in 1.5% and 1.9%, and malignant ventricular arrhythmias in 0.5% and 0.6%. No apparent differences in safety outcomes were observed between the groups.CONCLUSIONS: Among patients with a myocardial infarction and a left ventricular ejection fraction of at least 40%, beta-blocker therapy led to a lower risk of death or major adverse cardiovascular events than no beta-blocker therapy. (Funded by the Health South-East research program in Norway and others; BETAMI-DANBLOCK ClinicalTrials.gov numbers, NCT03646357 and NCT03778554.).
KW - St-elevation
KW - Metoprolol
KW - Mortality
KW - Trial
KW - Management
KW - Registry
KW - Disease
U2 - 10.1056/NEJMoa2505985
DO - 10.1056/NEJMoa2505985
M3 - Article
C2 - 40888716
SN - 0028-4793
JO - The New England journal of medicine
JF - The New England journal of medicine
ER -