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

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 (<3 months) follow-up with beta-blockers vs placebo/nothing:
  • 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.