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Purpose <p>While clinical benefits of beta-blockers are well-established in patients with acute myocardial infarction and reduced left ventricular ejection fraction (&lt; 40%) (AMI-rEF), but their efficacy in patients with low heart rates (H-Rs) remains unclear. This study aimed to evaluate the association between beta-blockers and 3-year mortality outcomes according to H-R in this population.</p> Methods <p>We analyzed 2,941 patients with AMI-rEF from two nationwide Korean registries, stratified by discharge H-R (&lt; 75 or ≥ 75 beats per minute). The primary outcome was 3-year all-cause death. Propensity score matching and multivariable Cox models adjusted for baseline differences.</p> Results <p>On unadjusted analysis, beta-blocker use was associated with lower all-cause death (16.1% vs. 23.3%; hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.52–0.76) and cardiac death (9.8% vs. 15.2%; HR, 0.59; 95% CI, 0.47–0.75). However, after adjustment, these associations were attenuated. Beta-blockers were associated with a significantly increased risk of nonfatal myocardial infarction (HR, 2.29; 95% CI, 1.14–4.59), particularly in patients with discharge H-R ≥ 75&#xa0;bpm (HR, 3.34; 95% CI, 1.13–9.92).</p> Conclusion <p>In patients with AMI-rEF, beta-blockers were not independently associated with significantly reduced all-cause death after adjustment, though a trend was observed. Notably, beta-blocker use increased the risk of nonfatal myocardial infarction, particularly at higher H-R. These findings suggest that the benefits of beta-blockers in this population may not be uniform and highlight the potential importance of H-R as a clinical marker to guide individualized beta-blocker use in the contemporary post-AMI setting.</p>

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Differential Outcomes of Beta-Blockers According to Heart Rate Following Myocardial Infarction with Reduced Left Ventricular Ejection Fraction

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月16日

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  • Seok Oh,
  • Ju Han Kim,
  • Kyung Hoon Cho,
  • Min Chul Kim,
  • Doo Sun Sim,
  • Young Joon Hong,
  • Youngkeun Ahn,
  • Myung Ho Jeong

摘要

Purpose

While clinical benefits of beta-blockers are well-established in patients with acute myocardial infarction and reduced left ventricular ejection fraction (< 40%) (AMI-rEF), but their efficacy in patients with low heart rates (H-Rs) remains unclear. This study aimed to evaluate the association between beta-blockers and 3-year mortality outcomes according to H-R in this population.

Methods

We analyzed 2,941 patients with AMI-rEF from two nationwide Korean registries, stratified by discharge H-R (< 75 or ≥ 75 beats per minute). The primary outcome was 3-year all-cause death. Propensity score matching and multivariable Cox models adjusted for baseline differences.

Results

On unadjusted analysis, beta-blocker use was associated with lower all-cause death (16.1% vs. 23.3%; hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.52–0.76) and cardiac death (9.8% vs. 15.2%; HR, 0.59; 95% CI, 0.47–0.75). However, after adjustment, these associations were attenuated. Beta-blockers were associated with a significantly increased risk of nonfatal myocardial infarction (HR, 2.29; 95% CI, 1.14–4.59), particularly in patients with discharge H-R ≥ 75 bpm (HR, 3.34; 95% CI, 1.13–9.92).

Conclusion

In patients with AMI-rEF, beta-blockers were not independently associated with significantly reduced all-cause death after adjustment, though a trend was observed. Notably, beta-blocker use increased the risk of nonfatal myocardial infarction, particularly at higher H-R. These findings suggest that the benefits of beta-blockers in this population may not be uniform and highlight the potential importance of H-R as a clinical marker to guide individualized beta-blocker use in the contemporary post-AMI setting.