Hot Line 3: BETAMI-DANBLOCK
31 Aug 2025
Hot Line ESC Congress 2025 Beta-blockers after MI in patients with LVEF ≥40%: BETAMI-DANBLOCK
“Two randomised trials with almost identical designs – the Norwegian BETAMI trial and the Danish DANBLOCK trial – were combined to assess the effects of beta-blocker therapy on cardiovascular outcomes in patients after myocardial infarction (MI) who had LVEF ≥40% and no clinical heart failure (HF),” explained Professor Dan Atar (Oslo University Hospital Ullevaal - Oslo, Norway).
The analysis included 5,574 participants randomised to long-term beta-blocker or no beta-blocker therapy. The median age was 63 years, 20.8% were women and 8.4% were on beta-blockers prior to enrolment. The primary endpoint was a composite of all-cause mortality, new MI, unplanned coronary revascularisation, ischaemic stroke, HF or malignant ventricular arrhythmias.
After a median follow-up of 3.5 years, the incidence of the primary endpoint was significantly lower in the beta-blocker group than in the no beta-blocker group (14.2% vs. 16.3%; hazard ratio [HR] 0.85; 95% CI 0.75 to 0.98; p=0.027).
Although not powered to address the subgroup of patients with mildly reduced LVEF (40–49%), the HR for the primary endpoint was 0.82 (95% CI 0.65 to 1.02) among 854 patients. All-cause mortality occurred in 4.2% and 4.4% of patients on beta-blocker therapy and no beta-blocker therapy, respectively (HR 0.94; 95% CI 0.73 to 1.21), while a new MI occurred in 5.0% and 6.7% of patients, respectively (HR 0.73; 95% CI 0.59 to 0.92). All-cause mortality, MI, HF or malignant ventricular arrhythmia at 30 days occurred in 0.8% of patients in the beta-blocker group and 1.1% in the no beta-blocker group.
Summarising the findings, Professor Eva Prescott (Copenhagen University Hospital - Bispebjerg and Frederiksberg - Copenhagen, Denmark) said: “Long-term beta-blocker therapy reduced the composite of all-cause mortality and major adverse cardiovascular events in this patient population, with a notable decrease in new MI. Our findings suggest that, despite advances in contemporary MI treatment, the beneficial effects of beta-blocker therapy remain clinically relevant, even in patients without reduced LVEF or HF. However, the results must be considered alongside other recent and ongoing trials of beta-blocker therapy after MI to determine their implications for clinical practice.”
