REDUCE-AMI: No Benefit to Beta Blockers Post-Myocardial Infarction If LVEF is Normal

News
Article

REDUCE-AMI concluded beta-blockers show no significant benefit following myocardial infarction among patients with normal left ventricular ejection fraction

Troels Yndigegn, MD | Credit: American College of Cardiology

Troels Yndigegn, MD
Credit: American College of Cardiology

Use of beta-blockers following myocardial infarction does not provide significant benefit for patients with a normal left ventricular ejection fraction (LVEF), according to results of the REDUCE-AMI trial.

A parallel-group, open-label trial assessing the effect of long-term beta-blocker use, results of the trial, which were presented at the American College of Cardiology 2024 (ACC.24) Annual Scientific Sessions, suggest long-term beta-blocker use was not associated with a significant reduction in risk of all-cause mortality or new myocardial infarction among patients with an LVEF of 50% or greater.

“I think that, following this study, many doctors will not find an indication to routinely treat all their patients with beta blockers following a heart attack,” said lead investigator Troels Yndigegn, MD, interventional cardiologist at Lund University in Sweden.2

For decades, the cardiology community has held true to the findings of landmark trials from the 1980s, purporting a benefit of long-term beta blocker use in patients with myocardial infarctions. As cited within the investigators’ manuscript, advances in management of post-myocardial infarction patient populations, including PCIs, hsCTN, RAAS blockade, high-intensity statins, and more, many within the field have questioned the benefit of beta-blocker use. Of note, investigators cite a meta-analysis suggesting long-term beta-blocker use failed to provide benefit in the era of modern reperfusion strategies.1

With this in mind, the investigators launched the Randomized Evaluation of Decreased Usage of Beta-Blockers after Acute Myocardial Infarction (REDUCE-AMI) study. A registry-based, prospective, open-label, parallel-group, randomized clinical trial, REDUCE-AMI was conducted across 45 centers in 3 countries. The trial included adult patients from the SWEDEHEART registry who provided written informed consent 1 to 7 days after myocardial infarction and who had undergone coronary angiography and echocardiography with a preserved LVEF.1

Patients included in the trial were randomized in a 1:1 ratio to long-term beta-blocker or no beta-blocker. The primary outcome of interest for the trial was a composite of all-cause mortality or new myocardial infarction. The trial also included multiple secondary outcomes of interest, such as all-cause mortality, cardiovascular mortality, myocardial infarction, hospitalization for atrial fibrillation, and hospitalization for heart failure.1

From September 2017 through May 2023, investigators enrolled a total of 5020 patients. Of note the majority of these patients (95.4%) were from Sweden. This cohort had a median age of 65 years, 22.5% were women, 35.2% had an ST-segment elevation myocardial infarction, and the median follow-up was 3.5 (Interquartile Range, 2.2 to 4.7) years. Investigators pointed out 2508 patients were randomized to beta-blockers and 2512 were randomized to no beta-blockers.1

Results of the study suggested a primary outcome event occurred among 7.9% of the beta-blocker group and among 8.3% of the no–beta-blocker group (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.79 to 1.16; P = .64). Further analysis suggested the long-term beta-blocker strategy did not contribute to a reduced incidence of all-cause mortality (3.9% in the beta-blocker group and 4.1% in the no– beta-blocker group), cardiovascular mortality (1.5% and 1.3%, respectively), myocardial infarction (4.5% and 4.7%, respectively) hospitalization for atrial fibrillation (1.1% and 1.4%, respectively) and hospitalization for heart failure (0.8% and 0.9%, respectively).1

Safety analyses of the trial suggested hospitalization for bradycardia, second- or third-degree atrioventricular block, hypotension, syncope, or implantation of a pacemaker occurred among 3.4% of the beta-blocker group and 3.2% of the no–beta-blocker group. Additionally, investigators noted asthma or chronic obstructive pulmonary disease occurred among 0.6% in both groups while hospitalization for stroke occurred among 1.4% and 1.8% of the beta-blocker and no-beta-blocker groups, respectively.1

“We believe that the evidence still supports beta blockers for patients with a large myocardial infarction that experience heart failure, but for patients with no signs of heart failure and a normal ejection fraction, this trial establishes that there’s no indication that routine use of beta blockers is beneficial," Yndigegn added.2

References:

  1. Yndigegn T, Lindahl B, Mars K, et al. Long-term Beta-blocker Treatment After Acute Myocardial Infarction And Preserved Left Ventricular Ejection Fraction - The REDUCE-AMI Trial. . Presented at: American College of Cardiology (ACC.24) Annual Scientific Session. April 6 – 8, 2024. Atlanta, GA.
  2. American College of Cardiology. Beta blockers may not benefit many heart attack survivors. American College of Cardiology. April 7, 2024. Accessed April 7, 2024. https://www.acc.org/About-ACC/Press-Releases/2024/04/07/14/12/beta-blockers-may-not-benefit-many-heart-attack-survivors.
Related Videos
Robert Rosenson, MD | Credit: Cura Foundation
Why Are Adult ADHD Cases Climbing?
A panel of 5 cardiovascular experts
A panel of 5 cardiovascular experts
Robert Rosenson, MD | Credit: Cura Foundation
Deepak Sambhara, MD | Image Credit: American Society of Retina Specialists
How Psoriatic Arthritis Presentation, Treatment Has Evolved
Optimizing Diabetes Therapies with New Classifications
Anthony Lembo, MD | Credit: Cleveland Clinic
Jonathan Barratt, MD | Credit: IgA Nephropathy Foundation
© 2024 MJH Life Sciences

All rights reserved.