Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction.
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
18 Apr 2024
18 Apr 2024
Historique:
medline:
19
4
2024
pubmed:
8
4
2024
entrez:
8
4
2024
Statut:
ppublish
Résumé
Most trials that have shown a benefit of beta-blocker treatment after myocardial infarction included patients with large myocardial infarctions and were conducted in an era before modern biomarker-based diagnosis of myocardial infarction and treatment with percutaneous coronary intervention, antithrombotic agents, high-intensity statins, and renin-angiotensin-aldosterone system antagonists. In a parallel-group, open-label trial performed at 45 centers in Sweden, Estonia, and New Zealand, we randomly assigned patients with an acute myocardial infarction who had undergone coronary angiography and had a left ventricular ejection fraction of at least 50% to receive either long-term treatment with a beta-blocker (metoprolol or bisoprolol) or no beta-blocker treatment. The primary end point was a composite of death from any cause or new myocardial infarction. From September 2017 through May 2023, a total of 5020 patients were enrolled (95.4% of whom were from Sweden). The median follow-up was 3.5 years (interquartile range, 2.2 to 4.7). A primary end-point event occurred in 199 of 2508 patients (7.9%) in the beta-blocker group and in 208 of 2512 patients (8.3%) in the no-beta-blocker group (hazard ratio, 0.96; 95% confidence interval, 0.79 to 1.16; P = 0.64). Beta-blocker treatment did not appear to lead to a lower cumulative incidence of the secondary end points (death from any cause, 3.9% in the beta-blocker group and 4.1% in the no-beta-blocker group; death from cardiovascular causes, 1.5% and 1.3%, respectively; myocardial infarction, 4.5% and 4.7%; hospitalization for atrial fibrillation, 1.1% and 1.4%; and hospitalization for heart failure, 0.8% and 0.9%). With regard to safety end points, hospitalization for bradycardia, second- or third-degree atrioventricular block, hypotension, syncope, or implantation of a pacemaker occurred in 3.4% of the patients in the beta-blocker group and in 3.2% of those in the no-beta-blocker group; hospitalization for asthma or chronic obstructive pulmonary disease in 0.6% and 0.6%, respectively; and hospitalization for stroke in 1.4% and 1.8%. Among patients with acute myocardial infarction who underwent early coronary angiography and had a preserved left ventricular ejection fraction (≥50%), long-term beta-blocker treatment did not lead to a lower risk of the composite primary end point of death from any cause or new myocardial infarction than no beta-blocker use. (Funded by the Swedish Research Council and others; REDUCE-AMI ClinicalTrials.gov number, NCT03278509.).
Sections du résumé
BACKGROUND
BACKGROUND
Most trials that have shown a benefit of beta-blocker treatment after myocardial infarction included patients with large myocardial infarctions and were conducted in an era before modern biomarker-based diagnosis of myocardial infarction and treatment with percutaneous coronary intervention, antithrombotic agents, high-intensity statins, and renin-angiotensin-aldosterone system antagonists.
METHODS
METHODS
In a parallel-group, open-label trial performed at 45 centers in Sweden, Estonia, and New Zealand, we randomly assigned patients with an acute myocardial infarction who had undergone coronary angiography and had a left ventricular ejection fraction of at least 50% to receive either long-term treatment with a beta-blocker (metoprolol or bisoprolol) or no beta-blocker treatment. The primary end point was a composite of death from any cause or new myocardial infarction.
RESULTS
RESULTS
From September 2017 through May 2023, a total of 5020 patients were enrolled (95.4% of whom were from Sweden). The median follow-up was 3.5 years (interquartile range, 2.2 to 4.7). A primary end-point event occurred in 199 of 2508 patients (7.9%) in the beta-blocker group and in 208 of 2512 patients (8.3%) in the no-beta-blocker group (hazard ratio, 0.96; 95% confidence interval, 0.79 to 1.16; P = 0.64). Beta-blocker treatment did not appear to lead to a lower cumulative incidence of the secondary end points (death from any cause, 3.9% in the beta-blocker group and 4.1% in the no-beta-blocker group; death from cardiovascular causes, 1.5% and 1.3%, respectively; myocardial infarction, 4.5% and 4.7%; hospitalization for atrial fibrillation, 1.1% and 1.4%; and hospitalization for heart failure, 0.8% and 0.9%). With regard to safety end points, hospitalization for bradycardia, second- or third-degree atrioventricular block, hypotension, syncope, or implantation of a pacemaker occurred in 3.4% of the patients in the beta-blocker group and in 3.2% of those in the no-beta-blocker group; hospitalization for asthma or chronic obstructive pulmonary disease in 0.6% and 0.6%, respectively; and hospitalization for stroke in 1.4% and 1.8%.
CONCLUSIONS
CONCLUSIONS
Among patients with acute myocardial infarction who underwent early coronary angiography and had a preserved left ventricular ejection fraction (≥50%), long-term beta-blocker treatment did not lead to a lower risk of the composite primary end point of death from any cause or new myocardial infarction than no beta-blocker use. (Funded by the Swedish Research Council and others; REDUCE-AMI ClinicalTrials.gov number, NCT03278509.).
Identifiants
pubmed: 38587241
doi: 10.1056/NEJMoa2401479
doi:
Substances chimiques
Adrenergic beta-Antagonists
0
Bisoprolol
Y41JS2NL6U
Metoprolol
GEB06NHM23
Banques de données
ClinicalTrials.gov
['NCT03278509']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
1372-1381Subventions
Organisme : Stockholm läns landsting
ID : FoUI-952158
Organisme : Hjärt-Lungfonden
ID : grant 20180187
Organisme : Hjärt-Lungfonden
ID : grant 20210216
Organisme : Hjärt-Lungfonden
ID : grant 20210273
Organisme : Hjärt-Lungfonden
ID : grant 20210423
Organisme : Eesti Teadusagentuur
ID : PRG2078
Organisme : Eesti Teadusagentuur
ID : PRG435
Organisme : Vetenskapsrådet
ID : Clinical therapy research, grant 2016-00493
Investigateurs
Troels Yndigegn
(T)
Anders Holmdahl
(A)
Anna Hammar
(A)
Gösta Westerberg
(G)
Josefine Orsjö
(J)
Lars Andersson
(L)
Malin Rylander
(M)
Peter Karlsson
(P)
Rikard Roupe
(R)
Alexander Wasmuth
(A)
Hans Tygesen
(H)
Haval Mustafa
(H)
Ilona Yevno
(I)
Susanne Johansson
(S)
Tomas Jonson
(T)
Marcus Lycksell
(M)
Ann Samnegård
(A)
Catrine Edström-Plüss
(C)
Fadi Jokhaji
(F)
Fredrik Wallentin
(F)
Mattias Ekström
(M)
Mattias Törnerud
(M)
Claes Hofmann-Bang
(C)
Johannes Aspberg
(J)
Patrik Hjalmarsson
(P)
Pia Lundman
(P)
Sara Aspberg
(S)
Tomas Jernberg
(T)
Frida Bergenholm
(F)
Peter Lindholm
(P)
Melinda Csegedi
(M)
Hanna Alwan
(H)
Kave Keshavarz
(K)
Linda Ärlehag
(L)
Mehmet Hamid
(M)
Mohamed Alharis Radawe
(M)
Nabeel Maarouf Mansour
(NM)
Ninve Palo
(N)
Oscar Eriksson
(O)
Qassim Awad
(Q)
Georgios Matthaiou
(G)
Carl Bergman
(C)
Carl Gustafsson
(C)
Greger Tysk
(G)
Julia Söderberg
(J)
Kristina Carlsson
(K)
Åsa Drakesby
(Å)
Kristina Sumske
(K)
Cornelia Varadan
(C)
Carl-David Dolata
(CD)
Ole Wagner
(O)
Henrik Wagner
(H)
Antheia Kissopoulou
(A)
Jörg Lauermann
(J)
Karim Abdulhadi
(K)
Marija Jakovlevski Hedbäck
(M)
Neshro Barmano
(N)
Tomasz Zwierzchlewski
(T)
Patric Karlström
(P)
Erik Hoffman
(E)
Moa Simonsson
(M)
Robert Edfors
(R)
Stefan Lind
(S)
Stina Smetana
(S)
Susanna Boquist
(S)
Marie Björenstam
(M)
Maria Wideqvist
(M)
Sara Bentzel
(S)
Annica Ravn-Fischer
(A)
Aferdita Llapaj Hetemi
(A)
Georgios Mourtzinis
(G)
Janet Moodh
(J)
Lars Klintberg
(L)
Martin Risenfors
(M)
Pär Parén
(P)
Pia Eriksson de Luca
(P)
Pia Linton Dahlöf
(P)
Therese Westberg
(T)
Ulf Axelsson
(U)
Fredrik Melchior
(F)
Charlotte Magnusson
(C)
Per Lundberg
(P)
Dimitri Matan
(D)
Göran Kennebäck
(G)
Karin Ljung
(K)
Layth Aladellie
(L)
Liyew Desta
(L)
Moayad Al-Azzawy
(M)
Staffan Eliasson
(S)
Thomas Flodin
(T)
Karolina Szummer
(K)
Anders Engström
(A)
David Olsson
(D)
Anja Fagerström
(A)
Anna Lenberg
(A)
Birgit Echeverri
(B)
Karl-Anders Nilsson
(KA)
Rakel Lindqvist-Rosengren
(R)
Viktoria Hermansson
(V)
Ola Hallén
(O)
Thomas Kellerth
(T)
Urban Haaga
(U)
Bodil Dahl
(B)
Björn Karlqvist
(B)
Diodor Cojucaru
(D)
Hannes Lynner
(H)
Marian Tudor
(M)
Per-Anders Wiklund
(PA)
Raluca Jumatate
(R)
Helena Wikström
(H)
Gunvor Finnas
(G)
Johannes Strandberg
(J)
Anna Alestig
(A)
Claudia Backlund
(C)
Gull-Britt Eriksson
(GB)
Susanne Hahne
(S)
Ali Muttar
(A)
Karin Lundgren
(K)
Magnus Peterson
(M)
Sofia Svensson
(S)
Ulrika Pettersson
(U)
Hanna Österman
(H)
Anna Holm
(A)
Eva Swahn
(E)
Maria Eriksson
(M)
Mats Pettersson
(M)
Mona Börjesson
(M)
Sofia Sederholm Lawesson
(S)
Ted Cabreira
(T)
Joakim Alfredsson
(J)
Asos Mirkhan
(A)
Carina Nilsson
(C)
Gustav Lund
(G)
Malin Kihlberg
(M)
Viveca Ritsinger
(V)
Anna Duckert
(A)
Anneli Olsson
(A)
Arash Mokhtari
(A)
Erik Rydberg
(E)
Gunilla Brolin
(G)
Jakob Lundgren
(J)
Josef Dankiewicz
(J)
Lotta Cinthio
(L)
Enisa Durakovic
(E)
Nazim Isma
(N)
Troels Yndigegn
(T)
David Erlinge
(D)
Robert Jablonowski
(R)
Klas Persson
(K)
Solveig Östberg
(S)
Sascha Wagner
(S)
Mia Grändås
(M)
Noorullah Moosawi
(N)
Åsa Törnqvist
(Å)
Malgorzata Pierscinska-Jedra
(M)
Maria Pettersson
(M)
Ulla Sahlen
(U)
Christofer Digerfeldt
(C)
Annelie Johansson
(A)
Emil Grönlund
(E)
Kamaran Mohammed
(K)
Marianne Erlandsson
(M)
Michael Eriksson
(M)
Göran Arstad
(G)
Anders Hallenberg
(A)
Carina Hägglund
(C)
Gunnar Boberg
(G)
Lis Kohlström
(L)
Luwam Habtemariam
(L)
Marie Jernvald
(M)
Marcus Arvidsson
(M)
Mats Frick
(M)
Mia Henning
(M)
Runa Sundelin
(R)
Katarina Mars
(K)
Robin Hofmann
(R)
Maria Stolt-Toremark
(M)
Mikael Olsson
(M)
Lisa Brandin
(L)
Cecilia Boltemo Nilsson
(C)
Philip Morsing
(P)
Staffan Stålnacke
(S)
Erik Benedik
(E)
Gabriel Fuchs
(G)
Jens Hällgren
(J)
Lina Mattsson
(L)
Louise Persson
(L)
Pernilla Ulander
(P)
Sara Själander
(S)
Fredrik Valham
(F)
Per Ottander
(P)
Rikard Hedelin
(R)
Therese Andersson
(T)
Ellinor Bergdahl
(E)
Kasper Andersen
(K)
Anton Gard
(A)
Axel Åkerblom
(A)
Christina Björklund
(C)
Helena Wall
(H)
Kai Eggers
(K)
Louise Robertsson
(L)
Maciej Olszowka
(M)
Maria Andreasson
(M)
Johan Sundström
(J)
Claes Held
(C)
Bertil Lindahl
(B)
Ann-Lis Wännman
(AL)
Angela Synnerö
(A)
Carina Gustavsson
(C)
Lisbeth Nilsson
(L)
Torbjörn Vik
(T)
Carina Andersson
(C)
Marika Lundqvist
(M)
Charlotta Myllylä
(C)
Saman Saidi-Seresht
(S)
Anna Mattsson
(A)
Anna-Sara Sundelin
(AS)
Emanuel Frimodig
(E)
Karin Johansson
(K)
Karin Sjöö
(K)
Margit Quist
(M)
Robin Gustafsson
(R)
Torbjörn Kalm
(T)
Yakak Akyuz
(Y)
Ole Fröbert
(O)
Eva Höglund
(E)
Jacob Vackdahl
(J)
Maria Kjesbo
(M)
Ulf Kajermo
(U)
Anders Ulvestam
(A)
Toomas Marandi
(T)
Risko Majas
(R)
Henri Kaljumäe
(H)
Jocelyne Benatar
(J)
Cathrine Patten
(C)
Patrick Gladding
(P)
Grainne Mcannalleyz
(G)
James Pemberton
(J)
Marguerite McLelland
(M)
Richard Luke
(R)
Melissa Spooner
(M)
Nick Fisher
(N)
Charlotte Mcnab
(C)
Vijaya Pera
(V)
Roselyn Pillay
(R)
Bertil Lindahl
(B)
Troels Yndigen
(T)
Robin Hofmann
(R)
Tomas Jernberg
(T)
David Erlinge
(D)
Annica Ravn-Fischer
(A)
Patric Karlström
(P)
Claes Held
(C)
Johan Sundström
(J)
Thomas Kellerth
(T)
Toomas Marandi
(T)
Estonia Jocelyn Benatar
(EJ)
Pelle Johansson
(P)
Gunnar Gislason
(G)
Herlev-Gentofte Hellerup
(HG)
Ulf Näslund
(U)
Kristian Thygesen
(K)
Eva Jacobsson
(E)
Robert Josif
(R)
Ylva Lindman
(Y)
Susanne Heller
(S)
Ulrika Andersson
(U)
Ollie Östlund
(O)
Albert Nilsson
(A)
Elisabeth Ärnström
(E)
Åsa Eck
(Å)
Kathrina Felix
(K)
David Karlsson
(D)
Gunilla Lindström
(G)
Eva Svensson
(E)
Jöns Weimarck
(J)
Fredrik Israelsson
(F)
Johan Jafner
(J)
Malin Nord
(M)
Helena Pettersson
(H)
Annika Edberg
(A)
Beata Pajak
(B)
Per-Olof Widström
(PO)
Stefan James
(S)
Hillevi Asplund
(H)
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