Beta-blocker therapy after acute coronary syndrome in patients without heart failure or reduced ejection fraction: a target-trial emulation study
Authors' conclusion
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.
Study context
- Population
- Acute coronary syndromes (ACS) patients without heart failure (HF) or left ventricular ejection fraction (LVEF) <40%, START-ANTIPLATELET registry
- Participants
- 1,315 patients
- Exposure
- β-blocker at discharge vs no β-blocker
- β-blockersn = 949
- Outcome
- All-cause death or myocardial infarction (MI)
- Follow-up
- 1 year
Methodological detailsmulticentre ACS registry, multicenter, inverse probability of treatment weighting
- Multicentre ACS registry
- Multicenter
- Inverse probability of treatment weighting
Main finding
As reported in the abstract
β-blockers vs Without β-blockersHazard ratio (95% CI)P value
Unweighted
0.63(0.31–1.26)
P = 0.192IPTW-adjusted
0.66(0.33–1.33)
P = 0.249Observational data: associations, not effects.
Further findings
Primary endpoint, STEMI subgroup (exploratory)
- Potentially more favourable association with β-blockers in STEMI; not uniformly reproduced across sensitivity analyses
- p-interaction=0.049
Original publication
Beta-blocker therapy after acute coronary syndrome in patients without heart failure or reduced ejection fraction: a target-trial emulation study. Eur J Prev Cardiol. Published 22 July 2026. doi:10.
Summarised from the published abstract; every number is checked against it