ArticlePloS one2025
Long-term benefit of vasodilating beta-blockers in acute myocardial infarction patients with mildly reduced left ventricular ejection fraction.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Beta-blockers have been considered the cornerstone of treatment for patients with acute myocardial infarction (AMI). However, long-term benefits of vasodilating beta-blockers remain uncertain. This study aimed to investigate the long-term clinical benefits of vasodilating beta-blockers compared to conventional beta-blockers in AMI patients with mildly reduced ejection fraction (mrEF). Among 13,624 patients who enrolled in the nationwide AMI database of South Korea, the KAMIR-NIH Registry, 2,662 AMI patients with mrEF, who were prescribed beta-blockers at discharge were selected for this study. The primary outcome was a composite of cardiac death, recurrent MI, or hospitalization for heart failure (HF) during 3-year follow up period. In the entire cohort, the use of vasodilating beta-blockers at discharge was associated with lower incidence of primary outcome at 3-year (hazard ratio [HR] 0.80; 95% confidence interval [CI], 0.62-0.98; P = 0.039) compared to the use of conventional beta-blockers at discharge. In the propensity score-matched (PSM) cohort, the use of vasodilating beta-blockers at discharge was also associated with a significantly lower incidence of primary outcome (HR, 0.66; 95% CI, 0.50-0.88; P = 0.004) compared to the use of conventional beta-blockers at discharge. Furthermore, in the PSM cohort, the use of vasodilating beta-blockers was associated with lower incidences of the cardiac death (HR, 0.60; 95% CI, 0.39-0.92; P = 0.020), hospitalization for HF (HR, 0.72; 95% CI, 0.46-0.98; P = 0.042), and all-cause death (HR, 0.67; 95% CI, 0.48-0.93; P = 0.017) compared to the use of conventional beta-blockers. However, no significant differences were observed between the groups in the incidences of recurrent MI (HR, 0.62; 95% CI, 0.34-1.14; P = 0.122), any revascularization (HR, 1.04; 95% CI, 0.76-1.42; P = 0.821), stroke (HR, 0.84; 95% CI, 0.44-1.60; P = 0.589), stent thrombosis (HR, 1.12; 95% CI, 0.40-3.11; P = 0.833). In AMI patients with mrEF, the use of vasodilating beta-blockers at discharge was associated with better long-term clinical outcomes compared to the use of conventional beta-blockers.
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