Beta-Blockers After MI: What Do Recent Trials Really Tell Us? It depends on EF
Beta-Blockers After MI: What Do Recent Trials Really Tell Us? It depends on EF
Source :Medscape,Sept , 2025. NEJM simultaneously with ESC2025.
1. Mixed trial results: New large studies show no consistent benefit of routine beta-blockers in revascularized MI patients with preserved EF.
2. REBOOT-CNIC (Spain & Italy, ≈8,500 pts):
• No difference in death, MI, or HF hospitalization.
• HR 1.04; p=0.63 → neutral result.
3. BETAMI–DANBLOCK (Norway & Denmark, ≈5,500 pts):
• Small benefit (HR 0.85; p=0.03).
• Driven mainly by fewer reinfarctions (~25–27% relative ↓).
• No mortality reduction.
4. CAPITAL-RCT (Japan):
• Patients with EF >40%.
• No clear signal of benefit when tested alone.
5. REDUCE-AMI (Sweden, ≈5,000 pts, EF >50%):
• No significant benefit vs no beta-blocker.
• Confirms uncertainty for patients with preserved EF.
6. Meta-analysis (LVEF 40–49%; pooled ≈1,900 pts from Spain/Italy, Scandinavia, Japan):
• 25% relative ↓ in composite events (HR 0.75).
• But absolute effect small (~19 fewer events overall); individual outcomes not significant.
7. Ventricular arrhythmias: Rare overall; no clear reduction with beta-blockers.
8. Stopping therapy: In REBOOT, withdrawing beta-blockers in stable patients did not increase ischemic risk.
9. Clinical take-home:
• EF < 40% (all countries): Clear benefit → beta-blockers remain standard.
• EF 40–50% (Scandinavian + pooled data): Possible modest benefit, mainly reinfarction reduction.
• EF > 50% (Japan + Sweden): No proven benefit; ongoing meta-analysis (>17,000 pts) may clarify.
10. Practical advice: Use beta-blockers selectively (HF, angina, arrhythmias, hypertension) — but avoid universal prescription for all post-MI patients.
