Study at a glance:

• Journal: New England Journal of Medicine, 2024

• Population: 5020 patients with acute myocardial infarction (MI) and left ventricular ejection fraction ≥50%

• Method: Open-label, randomized trial comparing long-term beta-blocker therapy (metoprolol/bisoprolol) vs. no beta-blocker use

• Key Finding: No significant difference in all-cause death or recurrent MI between groups after median 3.5 years

Summary:
This large multicenter RCT (REDUCE-AMI) investigated whether long-term beta-blocker therapy is beneficial for patients with acute MI and preserved ejection fraction. A total of 5020 patients (95% from Sweden) were randomized to beta-blocker treatment (n=2508) or no treatment (n=2512) following coronary angiography. Over a median follow-up of 3.5 years, the composite primary outcome of all-cause death or new MI occurred in 7.9% of the beta-blocker group vs. 8.3% of the no-beta-blocker group (HR 0.96; 95% CI, 0.79–1.16; P=0.64). Secondary outcomes—including cardiovascular death, recurrent MI, atrial fibrillation, and heart failure hospitalization—were also not significantly different. Safety outcomes, including bradycardia, hypotension, and stroke, were similar between groups.

Takeaway:
In the modern era of reperfusion and optimal secondary prevention therapy, long-term beta-blocker use does not reduce mortality or recurrent MI in patients with acute MI and preserved left ventricular function. Routine use in this population may be unnecessary.

Source:
REDUCE-AMI Investigators. Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction. N Engl J Med. 2024. doi:10.1056/NEJMoa2402136. Available at: https://www.nejm.org/doi/10.1056/NEJMoa2401479

Beta-Blockers Provide No Added Benefit After MI in Patients With Preserved Ejection Fraction