Beta blockers do not provide benefit after a myocardial infarction

The National Center for Cardiovascular Research (CNIC) has carried out a pre-specified analysis of the REBOOT clinical trial, published in the journal European Heart Journal Cardiovascular Pharmacotherapythrough which he has concluded that beta blockers do not provide any benefit after a myocardial infarctionneither in the acute nor in the chronic phase.

“These findings provide definitive evidence that beta-blockers do not improve outcomes in patients with preserved left ventricular ejection fractionregardless of whether they are in the acute or chronic phase after a myocardial infarction,” insisted the scientific director of the CNIC and principal investigator of this work, Dr. Borja Ibáñez.

In the opinion of the cardiologist at the Jiménez Díaz Foundation University Hospital in Madrid and group leader of the Red Biomedical Research Center for Cardiovascular Diseases (CIBERCV), the contribution “has enormous clinical relevanceas millions of patients around the world continue to take beta-blockers for years after a heart attack, with no clear evidence that they benefit.”

In this context, the CNIC has disclosed that, for more than four decades, These drugs have been the cornerstone of treatment after suffering this processsince the first clinical trials showed substantial benefits. However, they were carried out at a time before the generalized reperfusion (restoration of blood flow), modern antithrombotic therapy and high-intensity lipid reduction.

Now, different randomized clinical trials and recent meta-analyses have concluded the opposite, after which the question must be resolved whether beta-blockers could continue to be beneficial in the large population of patients who are long-term survivors of a myocardial infarction and who pass from the phase of acute coronary syndrome to what is currently called chronic coronary syndrome.

At this point, researchers have conducted this analysis, which is the largest randomized trial on the use of these medications after a myocardial infarction. The REBOOT study has recruited more than 8,500 patients in Spain and Italy and has evaluated the results based on the time elapsed since the heart attack, separating the first 12 months after the event (acute coronary syndrome phase) of the period after the year (chronic coronary syndrome).

They are not associated with a reduction in mortality

The results obtained show that this treatment was not associated with a reduction in mortalityrecurrent myocardial infarctions or hospitalizations for heart failure in either of the two aforementioned phases. Along with that, no benefits were observed during the first year after the heart attack nor during long-term follow-up in patients without reduced ejection fraction.

“The beta blockers do not confer protection in either context to patients with preserved ejection fraction,” has also been corroborated by the first author of this study, CNIC researcher and cardiologist at the Hospital Universitari Son Espases in Palma de Mallorca, Dr. Xavier Rosselló. In fact, this research also shows that patients in chronic coronary syndrome phase Those receiving higher doses of beta blockers tended to have worse outcomes.

This work “completes the evidence generated by REBOOT and related trials”, declared its co-investigator and general director of the CNIC, Dr. Valentín Fuster, who added that, “taken together, these findings question a long-established dogma”, to which he stressed that “simplify treatment when there are no proven benefits is as important as introducing new therapies.