European journal of preventive cardiology · 2026
Beta-blocker therapy after acute coronary syndrome in patients without heart failure or reduced ejection fraction: A target-trial emulation study.
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De Sio V, Gragnano F, Cesaro A, Galli M, Moscarella E, Berteotti M, Capolongo A, Pelliccia F, Verde G, Sabouret P, Acerbo V, Luciani M, Cappiello G, Dobrev D, Perone F, Patti G, Antonucci E, Pignatelli P, Pengo V, Gresele P, Cirillo P, Marcucci R, Calabrò P
Аннотация
AIMS: The benefits of β-blockers in patients with acute coronary syndromes (ACS) without chronic heart failure (HF) or left ventricular ejection fraction (LVEF) < 40% remain uncertain. We evaluated the association between β-blocker therapy and clinical outcomes in a multicenter, contemporary ACS registry.
METHODS: In the START-ANTIPLATELET registry (NCT02219984), patients were excluded if they had HF or LVEF <40%. Participants were stratified according to β-blocker use at discharge after ACS. A target trial emulation and inverse probability of treatment weighting (IPTW) were used. The primary endpoint was a composite of all-cause death or myocardial infarction (MI) at 1 year.
RESULTS: The primary analysis included 1,315 patients with ACS without HF or LVEF <40%, of whom 949 (72.2%) were discharged on β-blockers. At 1 year, the primary endpoint occurred in 21 (2.2%) patients receiving β-blockers versus 13 (3.6%) without β-blockers, and no significant association was observed (unweighted HR 0.63, 95% CI 0.31-1.26; p = 0.192; IPTW-adjusted HR 0.66, 95% CI 0.33-1.33; p = 0.249). Exploratory subgroup analyses suggested a potentially more favourable association of β-blocker therapy in patients with ST-segment elevation MI (p-interaction=0.049), although this finding was not uniformly reproduced across sensitivity analyses.
CONCLUSIONS: In a contemporary real-world cohort of ACS patients without HF or LVEF <40%, β-blocker therapy was prescribed in approximately 70% of patients and was not associated with a lower 1-year risk of death or MI.
METHODS: In the START-ANTIPLATELET registry (NCT02219984), patients were excluded if they had HF or LVEF <40%. Participants were stratified according to β-blocker use at discharge after ACS. A target trial emulation and inverse probability of treatment weighting (IPTW) were used. The primary endpoint was a composite of all-cause death or myocardial infarction (MI) at 1 year.
RESULTS: The primary analysis included 1,315 patients with ACS without HF or LVEF <40%, of whom 949 (72.2%) were discharged on β-blockers. At 1 year, the primary endpoint occurred in 21 (2.2%) patients receiving β-blockers versus 13 (3.6%) without β-blockers, and no significant association was observed (unweighted HR 0.63, 95% CI 0.31-1.26; p = 0.192; IPTW-adjusted HR 0.66, 95% CI 0.33-1.33; p = 0.249). Exploratory subgroup analyses suggested a potentially more favourable association of β-blocker therapy in patients with ST-segment elevation MI (p-interaction=0.049), although this finding was not uniformly reproduced across sensitivity analyses.
CONCLUSIONS: In a contemporary real-world cohort of ACS patients without HF or LVEF <40%, β-blocker therapy was prescribed in approximately 70% of patients and was not associated with a lower 1-year risk of death or MI.