geoffrey modest medical blogs

  Contrary to several current guidelines, prescribing beta-blockers in patients with acute MI and preserved ejection fraction does not seem to provide any benefit (see MI nl EF beta block not help NEJM2026 in dropbox, or DOI: 10.1056/NEJMoa2512686 ) Details : -- this study is a preplanned meta-analysis of five prior open-label trials that randomly assigned patients with a recent myocardial infarction, no other indications for beta-blocker therapy, and a left ventricular ejection fraction (LVEF) of at least 50% to receive either beta-blocker therapy or no beta-blocker therapy:     -- the REBOOT study (Treatment with Beta-Blockers after Myocardial Infarction without Reduced Ejection Fraction): 6459 patients     -- the REDUCE-AMI study (Randomized Evaluation of Decreased Usage of Beta-Blockers after Acute Myocardial Infarction): 4967 patients     -- the BETAMI study (Norwegian Beta-Blocker Treatment after Acute Myocardial Infarction in Revascularized P...

  A recent article found that continuing beta blocker therapy beyond one year after a myocardial infarction was not beneficial (see MI bblocker stopping NEJM2024  in dropbox, or DOI: 10.1056/NEJMoa2404204), from the ACTION Study Group in the ABYSS trial    Details: -- a multicenter open-label randomized noninferiority trial was conducted in 49 sites in France, with patients who had had a myocardial infarction with a left ventricular ejection fraction of least 40%, had no history of a cardiovascular event in the prior six months, and were receiving long-term beta blocker treatment. they were randomized to either continuing the beta blocker therapy or stopping it (the interruption group) -- mean age 64, 83% male -- median BMI 26, current smoker 21%, hypertension 43%, diabetes 20%, dyslipidemia 53% -- ST-segment elevated MI 63%, non-ST segment elevated MI 37% -- multi-vessel disease 52%, revascularization for index MI 95%, 23% were on prasugrel a...