Do Patients need Lifelong β-Blockers after an Uncomplicated Myocardial Infarction?

Abstract

The lifelong use of β-adrenoceptor antagonists (β-blockers) after a myocardial infarction (MI) has been the standard of care based on trials performed before the era of revascularization, when heart failure was common. Large randomized trials in the mid-1980s demonstrated that β-blockers played a major role in improving the in-hospital and long-term survival of patients admitted for MI. However, the implementation of rapid myocardial reperfusion led to a substantial survival benefit and a reduction of heart failure because of reduced infarct size. Modern large longitudinal registries did not provide sufficient evidence to support long-term β-blocker therapy in patients with uncomplicated acute MI. The long-term prescription of this therapy has become a matter of debate given the lack of contemporary evidence, frequent side effects, and treatment adherence issues. Furthermore, this shift into the reperfusion era led to a downgraded recommendation for the use of β-blockers in post-MI patients (class IIa B recommendation) in the 2017 European Society of Cardiology (ESC) recommendations for the treatment of ST-segment elevation MI (STEMI). Three large ongoing multicenter randomized trials (AβYSS, REDUCE-SWEDEHEART, and REBOOT-CNIC) are evaluating early discontinuation of β-blockers after an uncomplicated acute MI. The tested hypothesis is that β-blocker withdrawal is safe versus major adverse cardiovascular events and improves quality of life by reducing side effects. Thus, the present review summarizes the exhaustive evidence-based data for long-term β-blocker use after uncomplicated MI and the ongoing trials.

• Authors: Michel Zeitouni, Mathieu Kerneis, Benoit Lattuca, Paul Guedeney, Guillaume Cayla, Jean-Philippe Collet, Gilles Montalescot, Johanne Silvain
• Journal: American journal of cardiovascular drugs : drugs, devices, and other interventions (Am J Cardiovasc Drugs) Vol. 19 Issue 5 Pg. 431-438 (Oct 2019) ISSN: 1179-187X [Electronic] New Zealand
• PMID: 30828768 (Publication Type: Journal Article, Review)

Chemical References

• Adrenergic beta-Antagonists

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Heart Failure (drug therapy)
• Hospitalization
• Humans
• Myocardial Infarction (drug therapy)
• Quality of Life
• Time Factors