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Do Patients need Lifelong β-Blockers after an Uncomplicated Myocardial Infarction?
- Source :
-
American Journal of Cardiovascular Drugs . Oct2019, Vol. 19 Issue 5, p431-438. 8p. - Publication Year :
- 2019
-
Abstract
- The lifelong use of β-adrenoceptor antagonists (β-blockers) after a myocardial infarction (MI) has been the standard of care based on trials performed before the era of revascularization, when heart failure was common. Large randomized trials in the mid-1980s demonstrated that β-blockers played a major role in improving the in-hospital and long-term survival of patients admitted for MI. However, the implementation of rapid myocardial reperfusion led to a substantial survival benefit and a reduction of heart failure because of reduced infarct size. Modern large longitudinal registries did not provide sufficient evidence to support long-term β-blocker therapy in patients with uncomplicated acute MI. The long-term prescription of this therapy has become a matter of debate given the lack of contemporary evidence, frequent side effects, and treatment adherence issues. Furthermore, this shift into the reperfusion era led to a downgraded recommendation for the use of β-blockers in post-MI patients (class IIa B recommendation) in the 2017 European Society of Cardiology (ESC) recommendations for the treatment of ST-segment elevation MI (STEMI). Three large ongoing multicenter randomized trials (AβYSS, REDUCE-SWEDEHEART, and REBOOT-CNIC) are evaluating early discontinuation of β-blockers after an uncomplicated acute MI. The tested hypothesis is that β-blocker withdrawal is safe versus major adverse cardiovascular events and improves quality of life by reducing side effects. Thus, the present review summarizes the exhaustive evidence-based data for long-term β-blocker use after uncomplicated MI and the ongoing trials. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 11753277
- Volume :
- 19
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- American Journal of Cardiovascular Drugs
- Publication Type :
- Academic Journal
- Accession number :
- 138884993
- Full Text :
- https://doi.org/10.1007/s40256-019-00338-4