title: β blockers and mortality after myocardial infarction in patients without heart failure: multicentre prospective cohort study.
abstract: To assess the association between early and prolonged β blocker treatment and mortality after acute myocardial infarction.
  
  
  
  Multicentre prospective cohort study.
  
  
  
  Nationwide French registry of Acute ST- and non-ST-elevation Myocardial Infarction (FAST-MI) (at 223 centres) at the end of 2005.
  
  
  
  2679 consecutive patients with acute myocardial infarction and without heart failure or left ventricular dysfunction.
  
  
  
  Mortality was assessed at 30 days in relation to early use of β blockers (≤48 hours of admission), at one year in relation to discharge prescription, and at five years in relation to one year use.
  
  
  
  β blockers were used early in 77% (2050/2679) of patients, were prescribed at discharge in 80% (1783/2217), and were still being used in 89% (1230/1383) of those alive at one year. Thirty day mortality was lower in patients taking early β blockers (adjusted hazard ratio 0.46, 95% confidence interval 0.26 to 0.82), whereas the hazard ratio for one year mortality associated with β blockers at discharge was 0.77 (0.46 to 1.30). Persistence of β blockers at one year was not associated with lower five year mortality (hazard ratio 1.19, 0.65 to 2.18). In contrast, five year mortality was lower in patients continuing statins at one year (hazard ratio 0.42, 0.25 to 0.72) compared with those discontinuing statins. Propensity score and sensitivity analyses showed consistent results.
  
  
  
  Early β blocker use was associated with reduced 30 day mortality in patients with acute myocardial infarction, and discontinuation of β blockers at one year was not associated with higher five year mortality. These findings question the utility of prolonged β blocker treatment after acute myocardial infarction in patients without heart failure or left ventricular dysfunction.Trial registration Clinical trials NCT00673036.
authors.affiliation: Department of Cardiology, Hôpital Européen Georges Pompidou, 75015 Paris, France Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris-Descartes, Paris, France etienne.puymirat@egp.aphp.fr.
authors.forename: Etienne
authors.initials: E
authors.lastname: Puymirat
authors.affiliation: Department of Cardiology, Hôpital Européen Georges Pompidou, 75015 Paris, France Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris-Descartes, Paris, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Riant
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris-Descartes, Paris, France Department of Critical Care, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Aissaoui
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Paris, France Department of Dermatology and Allergology, Tenon Hospital, Paris, France Sorbonne University, Université Pierre et Marie Curie (UPMC-Paris 06), Paris, France INSERM U1135-CIMI, Paris, France.
authors.forename: Angèle
authors.initials: A
authors.lastname: Soria
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Paris, France Hôpital Bichat, Paris, France Université Paris Diderot, Paris, France INSERM U 698, Paris, France.
authors.forename: Gregory
authors.initials: G
authors.lastname: Ducrocq
authors.affiliation: Hôpital cardiologique du Haut Levêque, Pessac, France Université Bordeaux Segalen, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Coste
authors.affiliation: Hôpital du Bocage, Dijon, France Université de Bourgogne, Dijon, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
authors.affiliation: Hôpital St Joseph et St Luc, Lyon, France.
authors.forename: Jean François
authors.initials: JF
authors.lastname: Aupetit
authors.affiliation: Hôpital cardiologique Louis Pradel, Lyon, France Université Lyon 1, Lyon, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Bonnefoy
authors.affiliation: Clinique St Gatien, Tours, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blanchard
authors.affiliation: Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Cattan
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Paris, France Hôpital Bichat, Paris, France Université Paris Diderot, Paris, France INSERM U 698, Paris, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Steg
authors.affiliation: Hôpital Jean Minjoz, Besançon, France Université de Franche Comté, Besançon, France.
authors.forename: François
authors.initials: F
authors.lastname: Schiele
authors.affiliation: Department of Cardiology B and Epidemiology, Toulouse University Hospital, Toulouse, France UMR INSERM 1027, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
authors.affiliation: Institut Lorrain du Cœur et des Vaisseaux Université de Lorraine, Nancy, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Juillière
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Paris, France Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Paris, France.
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.affiliation: Department of Cardiology, Hôpital Européen Georges Pompidou, 75015 Paris, France Assistance Publique-Hôpitaux de Paris, Paris, France Université Paris-Descartes, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D003325:Coronary Care Units; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D010351:Patient Discharge / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000319:Adrenergic beta-Antagonists