Beta-blockers tied to reduced post-AMI reinfarction, mortality risk

  • Safi S & al.
  • Cochrane Database Syst Rev
  • 17 Dec 2019

  • International Clinical Digest
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Takeaway

  • Beta-blockers following acute myocardial infarction (AMI; suspected or diagnosed) are tied to reduced short-term reinfarction risk and reduced long-term mortality risk.
  • This Cochrane review found little effect on short-term post-AMI mortality risk, however.

Why this matters

  • Results from previous meta-analyses have been mixed on harms, neutral effects, and benefits.
  • This review is the first to follow the Cochrane process to review the evidence.

Key results

  • Bias risk was high in all but 1 of the trials.
  • Quality of evidence spanned the spectrum.
  • In short-term (
  • Reinfarction risk was reduced: risk ratio (RR), 0.82 (98% CI, 0.73-0.91; moderate-quality evidence).
  • Mortality risk (RRs) was unchanged:
    • All-cause: 0.94 (97.5% CI, 0.90-1.00; high-quality evidence).
    • Cardiovascular: 0.99 (95% CI, 0.91-1.08; moderate-quality evidence).
  • In the long term, risk (RRs) with beta-blockers:
    • Mortality:
      • All-cause: 0.93 (97.5% CI, 0.86-0.99; moderate-quality evidence).
      • Cardiovascular: 0.90 (98% CI, 0.83-0.98; moderate-quality evidence).
  • Study design

    • Meta-analysis of 63 trials with 85,550 participants (mean age, 57.4 years).
    • Funding: National Institute for Health Research, UK; others.

    Limitations

    • High bias risk in most included trials.