The routine use of beta-blockers after acute myocardial infarction (AMI) has been a historical recommendation based on studies prior to the era of percutaneous revascularization and modern secondary prevention. In recent years, the need to maintain them chronically in patients without heart failure and preserved ventricular function has been questioned.
The BETAMI-DANBLOCK study, conducted in Norway and Denmark, was a randomized, open-label trial that included 5,622 patients with AMI within the past 14 days, with preserved or mildly reduced ejection fraction (≥40%). All had undergone revascularization and were receiving standard secondary prevention therapy.
Patients were assigned to receive beta-blockers (mainly metoprolol 50 mg) or no beta-blockers. The primary endpoint was a composite of all-cause mortality and major cardiovascular events (reinfarction, unplanned revascularization, heart failure, stroke, or malignant ventricular arrhythmias), with a mean follow-up of 3.5 years.
Results showed that the beta-blocker strategy significantly reduced the risk of the primary endpoint compared to no beta-blockers. The benefit was consistent across subgroups, with no relevant safety differences.
Read also: ESC 2025 | DOUBLE-CHOICE: Anesthesia Strategies and Self-Expanding Valves in TAVI.
The investigators concluded that, in contemporary practice, beta-blockers maintain a relevant role in secondary prevention after AMI, even in patients with preserved or mildly reduced ventricular function.
Presented by Dan Atar in Major Late Breaking Trials, ESC 2025, Madrid, Spain.
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