No Benefit to Stop Beta-Blockers After MI

A French multicenter, open label, randomized, noninferiority trial suggested that interruption of long-term beta-blocker treatment was not found to be noninferior to a strategy of beta-blocker continuation in patients with a history of myocardial infarction (MI). A total of 3698 MI patients (mean age 63.5 years, 17.2% women) were randomized 1:1 to interruption or continuation of beta-blocker treatment between August 28, 2018, and September 12, 2022. All the patients had a left ventricular ejection fraction of at least 40% while receiving long-term beta-blocker treatment and had no history of a cardiovascular event in the previous 6 months. The median time between the last MI and randomization was 2.9 years with the median follow-up of 3.0 years. A primary-outcome event (a composite of death, nonfatal MI, nonfatal stroke, or hospitalization for cardiovascular reasons at the longest follow-up) occurred in 432 of 1812 patients (23.8%) in the interruption group and in 384 of 1821 patients (21.1%) in the continuation group, for a hazard ratio of 1.16 (P=0.44 for noninferiority). Beta-blocker interruption did not seem to improve the patients’ quality of life. The findings question the rationale and current US guidelines for stopping beta-blockers 1 year post an MI without another indications after decades of blanket endorsements for beta-blockers in MI. Source: https://www.nejm.org/