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Landmark trials of beta-blockers after myocardial infarction (MI) have led to the use of these agents in patients with stable coronary artery disease (CAD) and even in high-risk patients without CAD. To assess the effectiveness of beta-blockers for preventing coronary events in settings other than heart failure or post-acute MI, investigators used propensity score matching to compare outcomes with and without beta-blocker therapy in about half of more than 44,000 participants in the REACH registry who had prior MI, CAD without MI, or CAD risk factors only.
Median follow-up was 44 months. In both cohorts with CAD, the risk for cardiovascular death, MI, or stroke did not differ significantly between beta-blocker recipients and nonrecipients, whereas in the risk factor–only group, the risk was significantly higher (by 18%) in beta-blocker recipients than in nonrecipients. However, in patients with recent MI (≤1 year), beta-blockers were associated with a significant reduction in risk for major coronary events, including hospitalization for an atherothrombotic event or revascularization (odds ratio, 0.77; 95% confidence interval, 0.64–0.92).
Bangalore S et al. for the REACH Registry Investigators. β-blocker use and clinical outcomes in stable outpatients with and without coronary artery disease. JAMA 2012 Oct 3; 308:1340.
Comment
This study is not strong enough to overturn the trial evidence, but it does remind us that we lack recent trials of beta-blocker therapy. Moreover, although the authors emphasize the lack of association between beta-blockers and a reduced risk for cardiovascular events, their results do confirm a benefit in patients with a recent MI. These findings are consistent with recent guidelines that strongly endorse beta-blockers only for heart failure and for short-term use after MI, but not for prevention in patients with chronic coronary disease.