The effectiveness of beta-blockers in the treatment of patients suffering from myocardial infarction has been reduced. The therapy, considered one of the pillars in the treatment of cardiovascular events, was questioned in the Reduce-Ami study, published in the New England Journal of Medicine and presented at the American College of Cardiology congress, underway in Atlanta. According to the results, the use of these drugs would not reduce the risk of death or myocardial infarction in patients affected by this pathology.
“The use of beta-blockers after a heart attack is a consolidated clinical practice. It is a class of drugs that acts by inhibiting beta-adrenergic receptors – explains Ciro Indolfi, past president of the Italian Society of Cardiology (Sic) – and inducing a reduction in heart rate and blood pressure. However, the therapeutic efficacy of these drugs is still based today on the effect demonstrated in dated clinical studies, conducted before the diffusion of current revascularization techniques with stents, the systematic implementation of statins, the availability of effective drugs for primary and secondary prevention and modern antiplatelet therapies. Since these new treatments became accessible – he continues – the value of beta-blocker therapy in patients with myocardial infarction, without heart failure, has been questioned, but until now only observational studies were available which provided conflicting results”.
“Reduce-Ami therefore represents the first modern study on the benefits of beta-blockers and highlights the lack of effectiveness of this therapy in reduce the risk of death or heart attack in patients suffering from myocardial infarctiontreated with coronary angioplasty who have normal contractility of the heart”, underlines Pasquale Perrone Filardi, president of Sic and director of the school of specialization in diseases of the cardiovascular system of the Federico II University of Naples.
The study evaluated the effectiveness of beta-blocker therapy in 5,020 patients with an average age of 65 years, with acute myocardial infarction treated with angioplasty and with normal contractile function of the cardiac muscle. The research, conducted from September 2017 to May 2023 at 45 centers in Sweden, Estonia and New Zealand, compared the clinical course of the group of patients prescribed beta-blocker therapy versus those treated without these drugs. “The results showed that, approximately 3 and a half years after the start of the study, the incidence of death and a second heart attack were not significantly different in the two groups. No significant differences were recorded even in the number of hospitalizations for atrial fibrillation, heart failure, stroke or pacemaker implantation operations”, explains Indolfi.
“However, following this study, no negative signals were found regarding the safety of the treatment – clarifies Perrone Filardi – and we believe that the evidence is still in favor of beta-blockers for patients with large myocardial infarction, who have heart failure For patients with normal heart contractility, this study establishes, however, that there is no indication that the routine use of beta-blockers is beneficial. However, it may be too early to definitively exclude this type of therapy from the available tools in secondary prevention and further studies are therefore necessary.”
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