[en] [en] BACKGROUND: The evidence supporting beta-blocker therapy after myocardial infarction was established before the introduction of modern coronary reperfusion therapy and secondary prevention strategies.
METHODS: In an open-label, randomized trial with blinded end-point evaluation, conducted in Denmark and Norway, we assigned patients who had had a myocardial infarction and who had a left ventricular ejection fraction of at least 40%, in a 1:1 ratio, to receive long-term beta-blocker therapy within 14 days after the event or no beta-blocker therapy. The primary end point was a composite of death from any cause or major adverse cardiovascular events (new myocardial infarction, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmias).
RESULTS: A total of 5574 patients underwent randomization and were included in the main analyses - 2783 in the beta-blocker group and 2791 in the no-beta-blocker group. After a median follow-up of 3.5 years (interquartile range, 2.2 to 4.6), a primary end-point event had occurred in 394 patients (14.2%) in the beta-blocker group and in 454 patients (16.3%) in the no-beta-blocker group (hazard ratio, 0.85; 95% confidence interval [CI], 0.75 to 0.98; P = 0.03). Death from any cause occurred in 4.2% of the patients in the beta-blocker group and in 4.4% of those in the no-beta-blocker group; myocardial infarction occurred in 5.0% and 6.7%, respectively (hazard ratio, 0.73; 95% CI, 0.59 to 0.92), unplanned coronary revascularization in 3.9% and 3.9%, ischemic stroke in 1.6% and 1.3%, heart failure in 1.5% and 1.9%, and malignant ventricular arrhythmias in 0.5% and 0.6%. No apparent differences in safety outcomes were observed between the groups.
CONCLUSIONS: Among patients with a myocardial infarction and a left ventricular ejection fraction of at least 40%, beta-blocker therapy led to a lower risk of death or major adverse cardiovascular events than no beta-blocker therapy. (Funded by the Health South-East research program in Norway and others; BETAMI-DANBLOCK ClinicalTrials.gov numbers, NCT03646357 and NCT03778554.).
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Munkhaugen, John; Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway ; Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Oslo
Kristensen, Anna Meta D; Department of Cardiology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen
Halvorsen, Sigrun; Department of Cardiology, Oslo University Hospital Ullevaal, Oslo ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo
Holmager, Therese; Department of Cardiology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen
Olsen, Michael Hecht; Department of Clinical Medicine, University of Copenhagen, Copenhagen ; Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark
Bakken, Arnhild; Department of Cardiology, Oslo University Hospital Ullevaal, Oslo
Sehested, Thomas S G; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen
Ruddox, Vidar ; Department for Cardiology, Vestfold Hospital Trust, Vestfold, Norway
Mæng, Michael; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
Vikenes, Kjell; Department of Heart Disease, Haukeland University Hospital ; University of Bergen, Bergen, Norway
Jensen, Svend E; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
Steigen, Terje; Department of Cardiology, University Hospital of North Norway and the Arctic University of Tromsø, Tromsø, Norway
Lambrechtsen, Jess; Odense University Hospital Svendborg and Cardiovascular Research Unit, Odense, Denmark
Jortveit, Jarle; Department of Cardiology, Sørlandet Hospital Arendal, Arendal, Norway
Bovin, Ann; Department of Cardiology, Sygehus Lillebælt, Vejle, Denmark
Schirmer, Henrik; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo ; Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
Christiansen, Morten Krogh ; Department of Internal Medicine, Horsens Regional Hospital, Viborg, Denmark ; Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark
Wiseth, Rune; Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway ; Norwegian University of Science and Technology, Trondheim, Norway
Mikkelsen, Dennis; Department of Cardiology, Copenhagen University Hospital - Næstved, Slagelse, and Ringsted, Slagelse, Denmark ; Slagelse Hospital, Slagelse, Denmark
Larsen, Alf Inge; Department of Cardiology, Stavanger University Hospital and University of Bergen, Stavanger, Norway
Kjærgaard, Camilla Lyngby; Department of Cardiology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen
Andresen, Kristoffer; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo ; Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo
Gustafsson, Ida; Department of Cardiology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen
Tuseth, Vegard; Department of Heart Disease, Haukeland University Hospital ; University of Bergen, Bergen, Norway
Larsen, Mogens Lytken; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
Deeg, Peter Stefan; Department of Cardiology, Østfold Hospital Trust Kalnes, Grålum, Norway
Veien, Karsten; Department of Cardiology, Odense University Hospital, Odense, Denmark
Brønnum-Schou, Jens; Department of Cardiology, Copenhagen University Hospital - Amager and Hvidovre, Amager, Denmark
Pettersen, Alf-Åge Reistad; Department of Medicine, Vestre Viken Hospital Trust, Ringerike Hospital, Buskerud, Norway
Bang, Lia Evi; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen
Øie, Erik; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo ; Department of Internal Medicine, Diakonhjemmet Hospital, Oslo
Engstrøm, Thomas; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen
Borg, Eva Bostad; Innlandet Hospital Trust, Gjøvik, Norway
Kristensen, Kjeld; Department of Internal Medicine, Copenhagen University Hospital, Roenne, Denmark
Nymo, Ståle Haugset; Department of Cardiology, Nordland Hospital Trust, Bodø, Norway
Gislason, Gunnar; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
Vethe, Nils Tore; Department of Pharmacology, Oslo University Hospital and Department of Pharmacy, University of Oslo, Oslo
Abdulla, Jawdat Abdul Majid; Department of Medicine, Section of Cardiology, Glostrup Hospital, Copenhagen
Dammen, Toril; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo ; Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Oslo
Mouridsen, Mette Rauhe; Department of Cardiology, Copenhagen University Hospital, Herlev, Denmark
Bendz, Bjørn; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo ; Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo
Bertelsen, Mette Lykke Norgaard; Department of Cardiology, Copenhagen University Hospital-North Zealand Hospital, Hillerød, Denmark
Hove, Jens Dahlgaard; Department of Cardiology, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
Schierbeck, Louise; Department of Cardiology, Copenhagen University Hospital-North Zealand Hospital, Hillerød, Denmark
Snoer, Martin; Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
Davidsen, Cédric ; Université de Liège - ULiège > Département des sciences cliniques ; University of Bergen, Bergen, Norway
Egholm, Gro; Department of Cardiology, Odense University Hospital, Odense, Denmark
Thomsen, Kristian Korsgaard; Department of Cardiology, Sydvestjysk Sygehus, Esbjerg, Denmark
Jadou, Ghassan; Department of Cardiology, Sygehus Sønderjylland, Aabenraa, Denmark
Poenaru, Monica; Department of Cardiology, Sygehus Lillebælt, Kolding, Denmark
Krarup, Nikolaj Thure; Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark
Böttcher, Morten; Department of Cardiology, Gødstrup Hospital, Herning, Denmark
Stæhr, Peter Bisgaard; Department of Cardiology, North Denmark Regional Hospital, Hjoerring, Denmark
Zwisler, Ann-Dorthe; Clinic for Palliative Medicine, Rehabilitation and Patient-centered Care, Department of Oncology, Rigshospitalet, Copenhagen ; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
Edvardsen, Thor; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo ; Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo
Torp-Pedersen, Christian; Department of Cardiology, Copenhagen University Hospital-North Zealand Hospital, Hillerød, Denmark
Otterstad, Jan Erik; Department for Cardiology, Vestfold Hospital Trust, Vestfold, Norway
Lange, Theis; Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen
Fagerland, Morten W; Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo
Atar, Dan; Department of Cardiology, Oslo University Hospital Ullevaal, Oslo ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo
Prescott, Eva; Department of Cardiology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen
