Titre
Routine beta-blocker therapy after acute coronary syndromes: The end of an era?
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Johner, N.
Auteure/Auteur
Gencer, B.
Auteure/Auteur
Roffi, M.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
1365-2362
Statut éditorial
Publié
Date de publication
2024-12
Volume
54
Numéro
12
Première page
e14309
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Publication Status: ppublish
Résumé
Beta-blocker therapy, a treatment burdened by side effects including fatigue, erectile dysfunction and depression, was shown to reduce mortality and cardiovascular events after acute coronary syndromes (ACS) in the pre-coronary reperfusion era. Potential mechanisms include protection from ventricular arrhythmias, increased ischaemia threshold and prevention of left ventricular (LV) adverse remodelling. With the advent of early mechanical reperfusion and contemporary pharmacologic secondary prevention, the benefit of beta-blockers after ACS in the absence of LV dysfunction has been challenged.
The present narrative review discusses the contemporary evidence based on searching the PubMed database and references in identified articles.
Recently, the REDUCE-AMI trial-the first adequately powered randomized trial in the reperfusion era to test beta-blocker therapy after myocardial infarction with preserved left ventricular ejection fraction (LVEF)-showed no benefit on the composite of all-cause death or myocardial infarction over a median 3.5-year follow-up. While the benefit of beta-blockers in patients with reduced LVEF remains undisputed, their value in post-ACS patients with mildly reduced systolic function (LVEF 41%-49%) has not been studied in contemporary randomized trials; in this setting, observational studies have suggested a reduction in cardiovascular events with these agents. The adequate duration of beta-blocker therapy remains unknown, but observational data suggests that any mortality benefit may be lost beyond 1-12 months after ACS in patients with LVEF >40%.
We believe that there is sufficient evidence to abandon routine beta-blocker prescription in post-ACS patients with preserved LV systolic function.
The present narrative review discusses the contemporary evidence based on searching the PubMed database and references in identified articles.
Recently, the REDUCE-AMI trial-the first adequately powered randomized trial in the reperfusion era to test beta-blocker therapy after myocardial infarction with preserved left ventricular ejection fraction (LVEF)-showed no benefit on the composite of all-cause death or myocardial infarction over a median 3.5-year follow-up. While the benefit of beta-blockers in patients with reduced LVEF remains undisputed, their value in post-ACS patients with mildly reduced systolic function (LVEF 41%-49%) has not been studied in contemporary randomized trials; in this setting, observational studies have suggested a reduction in cardiovascular events with these agents. The adequate duration of beta-blocker therapy remains unknown, but observational data suggests that any mortality benefit may be lost beyond 1-12 months after ACS in patients with LVEF >40%.
We believe that there is sufficient evidence to abandon routine beta-blocker prescription in post-ACS patients with preserved LV systolic function.
PID Serval
serval:BIB_565CC8139A0B
PMID
Open Access
Oui
Date de création
2024-09-13T14:06:11.642Z
Date de création dans IRIS
2025-05-20T20:23:01Z
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Nom
39257189.pdf
Version du manuscrit
published
Licence
https://creativecommons.org/licenses/by/4.0
Taille
203.24 KB
Format
Adobe PDF
PID Serval
serval:BIB_565CC8139A0B.P001
URN
urn:nbn:ch:serval-BIB_565CC8139A0B2
Somme de contrôle
(MD5):8f2452a41d59c433236672ecac575b4b