Evaluating Beta-Blockers In Patients With/Without Prior Myocardial Infarction

Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology, Associate Professor of Medicine, New York University School of MedicineMedicalReseach.com Interview with:
Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI,
Director of Research, Cardiac Catheterization Laboratory,
Director, Cardiovascular Outcomes Group,
The Leon H. Charney Division of Cardiology,
Associate Professor of Medicine,
New York University School of Medicine New York, NY 10016.

Medical Research: What are the main findings of the study?

Dr. Bangalore: Using data from the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial, we found that β-blocker use in patients with prior myocardial infarction but no heart failure was associated with a lower composite cardiovascular outcome, driven mainly by lower risk of recurrent myocardial infarction with no difference in mortality. However, in patients without prior myocardial infarction there was no benefit of β-blocker use with a suggestion of increase in stroke risk.

Medical Research: What was most surprising about the results?

Dr. Bangalore: The lack of mortality benefit in patients with prior myocardial infarction was surprising. In addition, although the finding of increase in stroke risk in those without a prior myocardial infarction is surprising, this has been consistently shown in our prior analysis from the REACH registry, in the POISE trial and multiple randomized trials of beta blockers for hypertension

Medical Research: What should clinicians and patients take away from your report?

Dr. Bangalore: Clinicians should really think whether beta blockers are indicated for a patient subgroup before prescribing these medications. In patients with an myocardial infarction, the current data suggests short term use of beta blockers and longer term only in patients with left ventricular systolic dysfunction. In addition, for patients without an myocardial infarction, the bar is higher and one really needs to consider the risks and benefits before prescribing this group of agents.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Bangalore: We need randomized trials to assess the outcomes with beta blockers in contemporary practice and to understand how long a duration beta blockers need to be continued post myocardial infarction.

Citation:

Beta-Blockers and Cardiovascular Events in Patients With and Without Myocardial Infarction: Post Hoc Analysis From the CHARISMA Trial

Sripal Bangalore, Deepak L. Bhatt, Ph. Gabriel Steg, Michael A. Weber, William E. Boden, Christian W. Hamm, Gilles Montalescot, Amy Hsu, Keith A.A. Fox, and A. Michael Lincoff

Circ Cardiovasc Qual Outcomes. 2014;CIRCOUTCOMES.114.001073published online before print September 30 2014, doi:10.1161/CIRCOUTCOMES.114.001073

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