Safety of beta-blocker discontinuation after acute coronary syndromes with preserved or mildly reduced left ventricular ejection fraction: a target trial emulation from a real-world cohort

Johner, N; Branca, M; Carballo, D; Baggio, S; Nanchen, D; Tessitore, E; Räber, L; Lüscher, TF; Matter, CM; Windecker, S; Rodondi, N; Mach, F; Gencer, B

doi:10.1093/eurjpc/zwae346

Coronary disease & ACS

Safety of beta-blocker discontinuation after acute coronary syndromes with preserved or mildly reduced left ventricular ejection fraction: a target trial emulation from a real-world cohort

Eur J Prev CardiolPublished 26 Oct 2024Target trial emulation from a prospective cohort

Main finding · MACEResultAdjusted hazard ratio 0.98 95% CI 0.72–1.34

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Authors' conclusion

Beta-blocker discontinuation within 12 months following ACS with LVEF ≥40% was not associated with an increased risk of MACE compared with long-term beta-blocker therapy.

Study context

Population: Patients hospitalized for acute coronary syndromes (ACS) with left ventricular ejection fraction (LVEF) ≥40% and beta-blockers at dischargefrom cohort n = 3762
Participants: 2,077 patients

Exposure: Beta-blocker discontinuation within 12 months vs continuation after ACS
Discontinuationn = 319
Continuationn = 1,758reference
Outcome: MACE:
CV death
MI
Stroke
TIA
Unplanned coronary revascularization
Unstable angina hospitalization
Follow-up: 4 years

Methodological detailsmulticentre, inverse probability weighting

Multicentre
Inverse probability weighting

Main finding

MACE

Adjusted hazard ratio

0.98

95% CI 0.72–1.34

P = 0.91

By group

Discontinuation14.1%

Continuation14.3%

Discontinuation vs Continuation

adjusted HR 0.98 (95% CI 0.72–1.34); P = 0.91

As reported in the abstract

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk with discontinuation ←→ Higher risk with discontinuation →	Adjusted HR (CI)
MACE by ACS type (subgroup)Discontinuation vs Continuation · STEMI	0.512	1.46 (0.99–2.16)
MACE by ACS type (subgroup)Discontinuation vs Continuation · NSTEMI	0.512	0.70 (0.40–1.22)
	0.512Adjusted hazard ratio (log scale)

Major adverse cardiovascular events (MACE) by ACS type (subgroup): interaction P = 0.033

MACE by LVEF (subgroup)

No interaction with LVEF: P for interaction = 0.68

Original publication

Safety of beta-blocker discontinuation after acute coronary syndromes with preserved or mildly reduced left ventricular ejection fraction: a target trial emulation from a real-world cohort. Eur J Prev Cardiol. Published 26 October 2024. doi:10.1093/eurjpc/zwae346

Read the original article ↗

Summarised from the published abstract; every number is checked against it