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

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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.

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Authors and Affiliations

  1. Sorbonne Université, ACTION Study Group, APHP, INSERM, UMRS 1166, Hôpital Pitié-Salpêtrière, Institut de Cardiologie- Bureau 7-2ème étage, 47-83 bld de l’Hôpital, 75013, Paris, France

    Michel Zeitouni, Mathieu Kerneis, Benoit Lattuca, Paul Guedeney, Jean-Philippe Collet, Gilles Montalescot & Johanne Silvain

  2. ACTION Study Group, Cardiology Department, Nîmes University Hospital, Montpellier University, Nîmes, France

    Benoit Lattuca & Guillaume Cayla

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  1. Michel Zeitouni
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Correspondence to Johanne Silvain.

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Conflict of interest

M. Zeitouni has received research grants from Institut Servier and Federation Française de Cardiologie. M. Kerneis has received research grants from Sanofi, Institut Servier, and Federation Française de Cardiologie. B. Lattuca has received research grants from Biotronik, Daiichi Sankyo, and Fédération Française de Cardiologie; consultant fees from Daiichi Sankyo and Eli Lilly; and lecture fees from AstraZeneca and Novartis. P. Guedeney has no financial relationships or conflicts of interest. G. Cayla has received consulting and lecture fees from Abbott Vascular, AstraZeneca, Bayer, BMS, Boehringer-Ingelheim, Boston Scientific, CLS Behring, Daiichi Sankyo, Eli Lilly, Iroko Cardio, Novartis, and Pfizer. J.P. Collet has received research grants or honoraria from AstraZeneca, Bayer, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly, Fédération Française de Cardiologie, Lead-Up, Medtronic, MSD, Sanofi-Aventis, and WebMD. G. Montalescot has received research grants or honorarium from Abbott, Amgen, Actelion, AstraZeneca, Bayer, Boehringer-Ingelheim, Boston Scientific, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women’s Hospital, Cardiovascular Research Foundation, Daiichi Sankyo, Idorsia, Lilly, Europa, Elsevier, Fédération Française de Cardiologie, ICAN, Medtronic, Journal of the American College of Cardiology, Lead-Up, Menarini, MSD, Novo Nordisk, Pfizer, Sanofi, Servier, The Mount Sinai School, TIMI Study Group, and WebMD. J. Silvain has received consulting fees from AstraZeneca, Bayer, Boehringer Ingelheim, Gilead Science and Sanofi-Aventis, speaker honorariums from AstraZeneca, Amgen, Bayer, Algorythm, and Sanofi-Aventis and travel support from Amgen, AstraZeneca, Bayer, and Bristol-Myers Squibb.

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Zeitouni, M., Kerneis, M., Lattuca, B. et al. Do Patients need Lifelong β-Blockers after an Uncomplicated Myocardial Infarction?. Am J Cardiovasc Drugs 19, 431–438 (2019). https://doi.org/10.1007/s40256-019-00338-4

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