β blockers after myocardial infarction with mildly reduced ejection fraction: an individual patient data meta-analysis of randomised controlled trials.
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| Title: | β blockers after myocardial infarction with mildly reduced ejection fraction: an individual patient data meta-analysis of randomised controlled trials. |
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| Authors: | Rossello, Xavier (AUTHOR), Prescott, Eva Irene Bossano (AUTHOR), Kristensen, Anna Meta Dyrvig (AUTHOR), Latini, Roberto (AUTHOR), Fuster, Valentin (AUTHOR), Fagerland, Morten Wang (AUTHOR), Pocock, Stuart J (AUTHOR), Halvorsen, Sigrun (AUTHOR), Dominguez-Rodriguez, Alberto (AUTHOR), Holmager, Therese Lucia Friis (AUTHOR), Sanchez, Pedro Luis (AUTHOR), Bakken, Arnhild (AUTHOR), Raposeiras-Roubin, Sergio (AUTHOR), Jensen, Svend Eggert (AUTHOR), Kimura, Takeshi (AUTHOR), Ottani, Filippo (AUTHOR), Lambrechtsen, Jess (AUTHOR), Anguita, Manuel (AUTHOR), Ozasa, Neiko (AUTHOR), Atar, Dan (AUTHOR) |
| Source: | Lancet. Sep2025, Vol. 406 Issue 10508, p1128-1137. 10p. |
| Subjects: | Myocardial infarction, Adrenergic beta blockers, Ventricular ejection fraction, Heart failure, Medical record databases, Randomized controlled trials, Treatment effectiveness |
| Abstract: | The effects of β-blocker therapy on clinical outcomes in patients with myocardial infarction and mildly reduced (40–49%) left ventricular ejection fraction (LVEF) are largely unknown. Four recently conducted randomised trials tested the efficacy of β blockers after a recent myocardial infarction in patients without reduced LVEF (LVEF ≥40%). However, none were individually powered to assess these effects in the subgroup of patients with mildly reduced LVEF. We aimed to assess the efficacy of β blockers in patients with myocardial infarction and mildly reduced LVEF during the index hospitalisation. We conducted an individual patient-level meta-analysis of patients with mildly reduced LVEF and no history or signs of heart failure from four recent clinical trials. These studies were included because they were randomised controlled trials testing long-term effects (median follow-up >1 year) of oral β-blocker therapy in patients who recently had a myocardial infarction (randomisation within 14 days) and had mildly reduced LVEF. No further studies were found in a systematic review (Jan 1, 2020 to June 26, 2025). A one-stage, fixed-effects, Cox proportional hazards regression model was used to assess the treatment effect of β blockers on the predefined primary composite endpoint of all-cause death, new myocardial infarction, or heart failure. All endpoints were independently adjudicated. This meta-analysis was registered with PROSPERO (CRD420251023480). 1885 patients with myocardial infarction and mildly reduced LVEF were included in the meta-analysis: 979 from the REBOOT trial, 422 from the BETAMI trial, 430 from the DANBLOCK trial, and 54 from the CAPITAL-RCT trial. Overall, 991 patients were assigned to β blockers and 894 to control (no β blockers). The primary composite endpoint occurred in 106 patients (32·6 events per 1000 patient-years) in the β-blocker group and 129 patients (43·0 per 1000 patient-years) in the no β-blocker group (hazard ratio 0·75 [95% CI 0·58–0·97]; p=0·031). No heterogeneity between the trials (trial-by-treatment p interaction =0·95) or between countries of enrolment was observed (p interaction =0·98). In patients with acute myocardial infarction with mildly reduced LVEF without history or clinical signs of heart failure, β-blocker therapy was associated with a reduction in the composite of all-cause death, new myocardial infarction, or heart failure. These results extend the known benefits of these agents in patients with myocardial infarction with reduced LVEF to the subgroup with mildly reduced LVEF. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Danish Heart Foundation, Novo Nordisk Foundation, South-Eastern Norway Regional Health Authority, and Research Council of Norway. [ABSTRACT FROM AUTHOR] |
| Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Psychology and Behavioral Sciences Collection |
| FullText | Text: Availability: 0 |
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| Header | DbId: pbh DbLabel: Psychology and Behavioral Sciences Collection An: 187893566 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: β blockers after myocardial infarction with mildly reduced ejection fraction: an individual patient data meta-analysis of randomised controlled trials. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Rossello%2C+Xavier%22">Rossello, Xavier</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Prescott%2C+Eva+Irene+Bossano%22">Prescott, Eva Irene Bossano</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kristensen%2C+Anna+Meta+Dyrvig%22">Kristensen, Anna Meta Dyrvig</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Latini%2C+Roberto%22">Latini, Roberto</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Fuster%2C+Valentin%22">Fuster, Valentin</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Fagerland%2C+Morten+Wang%22">Fagerland, Morten Wang</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Pocock%2C+Stuart+J%22">Pocock, Stuart J</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Halvorsen%2C+Sigrun%22">Halvorsen, Sigrun</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Dominguez-Rodriguez%2C+Alberto%22">Dominguez-Rodriguez, Alberto</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Holmager%2C+Therese+Lucia+Friis%22">Holmager, Therese Lucia Friis</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Sanchez%2C+Pedro+Luis%22">Sanchez, Pedro Luis</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Bakken%2C+Arnhild%22">Bakken, Arnhild</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Raposeiras-Roubin%2C+Sergio%22">Raposeiras-Roubin, Sergio</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Jensen%2C+Svend+Eggert%22">Jensen, Svend Eggert</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kimura%2C+Takeshi%22">Kimura, Takeshi</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ottani%2C+Filippo%22">Ottani, Filippo</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Lambrechtsen%2C+Jess%22">Lambrechtsen, Jess</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Anguita%2C+Manuel%22">Anguita, Manuel</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ozasa%2C+Neiko%22">Ozasa, Neiko</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Atar%2C+Dan%22">Atar, Dan</searchLink> (AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Lancet%22">Lancet</searchLink>. Sep2025, Vol. 406 Issue 10508, p1128-1137. 10p. – Name: Subject Label: Subjects Group: Su Data: <searchLink fieldCode="DE" term="%22Myocardial+infarction%22">Myocardial infarction</searchLink><br /><searchLink fieldCode="DE" term="%22Adrenergic+beta+blockers%22">Adrenergic beta blockers</searchLink><br /><searchLink fieldCode="DE" term="%22Ventricular+ejection+fraction%22">Ventricular ejection fraction</searchLink><br /><searchLink fieldCode="DE" term="%22Heart+failure%22">Heart failure</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+record+databases%22">Medical record databases</searchLink><br /><searchLink fieldCode="DE" term="%22Randomized+controlled+trials%22">Randomized controlled trials</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+effectiveness%22">Treatment effectiveness</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: The effects of β-blocker therapy on clinical outcomes in patients with myocardial infarction and mildly reduced (40–49%) left ventricular ejection fraction (LVEF) are largely unknown. Four recently conducted randomised trials tested the efficacy of β blockers after a recent myocardial infarction in patients without reduced LVEF (LVEF ≥40%). However, none were individually powered to assess these effects in the subgroup of patients with mildly reduced LVEF. We aimed to assess the efficacy of β blockers in patients with myocardial infarction and mildly reduced LVEF during the index hospitalisation. We conducted an individual patient-level meta-analysis of patients with mildly reduced LVEF and no history or signs of heart failure from four recent clinical trials. These studies were included because they were randomised controlled trials testing long-term effects (median follow-up >1 year) of oral β-blocker therapy in patients who recently had a myocardial infarction (randomisation within 14 days) and had mildly reduced LVEF. No further studies were found in a systematic review (Jan 1, 2020 to June 26, 2025). A one-stage, fixed-effects, Cox proportional hazards regression model was used to assess the treatment effect of β blockers on the predefined primary composite endpoint of all-cause death, new myocardial infarction, or heart failure. All endpoints were independently adjudicated. This meta-analysis was registered with PROSPERO (CRD420251023480). 1885 patients with myocardial infarction and mildly reduced LVEF were included in the meta-analysis: 979 from the REBOOT trial, 422 from the BETAMI trial, 430 from the DANBLOCK trial, and 54 from the CAPITAL-RCT trial. Overall, 991 patients were assigned to β blockers and 894 to control (no β blockers). The primary composite endpoint occurred in 106 patients (32·6 events per 1000 patient-years) in the β-blocker group and 129 patients (43·0 per 1000 patient-years) in the no β-blocker group (hazard ratio 0·75 [95% CI 0·58–0·97]; p=0·031). No heterogeneity between the trials (trial-by-treatment p interaction =0·95) or between countries of enrolment was observed (p interaction =0·98). In patients with acute myocardial infarction with mildly reduced LVEF without history or clinical signs of heart failure, β-blocker therapy was associated with a reduction in the composite of all-cause death, new myocardial infarction, or heart failure. These results extend the known benefits of these agents in patients with myocardial infarction with reduced LVEF to the subgroup with mildly reduced LVEF. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Danish Heart Foundation, Novo Nordisk Foundation, South-Eastern Norway Regional Health Authority, and Research Council of Norway. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1016/S0140-6736(25)01592-2 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 10 StartPage: 1128 Subjects: – SubjectFull: Myocardial infarction Type: general – SubjectFull: Adrenergic beta blockers Type: general – SubjectFull: Ventricular ejection fraction Type: general – SubjectFull: Heart failure Type: general – SubjectFull: Medical record databases Type: general – SubjectFull: Randomized controlled trials Type: general – SubjectFull: Treatment effectiveness Type: general Titles: – TitleFull: β blockers after myocardial infarction with mildly reduced ejection fraction: an individual patient data meta-analysis of randomised controlled trials. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Rossello, Xavier – PersonEntity: Name: NameFull: Prescott, Eva Irene Bossano – PersonEntity: Name: NameFull: Kristensen, Anna Meta Dyrvig – PersonEntity: Name: NameFull: Latini, Roberto – PersonEntity: Name: NameFull: Fuster, Valentin – PersonEntity: Name: NameFull: Fagerland, Morten Wang – PersonEntity: Name: NameFull: Pocock, Stuart J – PersonEntity: Name: NameFull: Halvorsen, Sigrun – PersonEntity: Name: NameFull: Dominguez-Rodriguez, Alberto – PersonEntity: Name: NameFull: Holmager, Therese Lucia Friis – PersonEntity: Name: NameFull: Sanchez, Pedro Luis – PersonEntity: Name: NameFull: Bakken, Arnhild – PersonEntity: Name: NameFull: Raposeiras-Roubin, Sergio – PersonEntity: Name: NameFull: Jensen, Svend Eggert – PersonEntity: Name: NameFull: Kimura, Takeshi – PersonEntity: Name: NameFull: Ottani, Filippo – PersonEntity: Name: NameFull: Lambrechtsen, Jess – PersonEntity: Name: NameFull: Anguita, Manuel – PersonEntity: Name: NameFull: Ozasa, Neiko – PersonEntity: Name: NameFull: Atar, Dan IsPartOfRelationships: – BibEntity: Dates: – D: 13 M: 09 Text: Sep2025 Type: published Y: 2025 Identifiers: – Type: issn-print Value: 01406736 Numbering: – Type: volume Value: 406 – Type: issue Value: 10508 Titles: – TitleFull: Lancet Type: main |
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