0114: Association between beta-blocker therapy and mortality in patients without heart failure or severe left ventricular dysfunction after acute myocardial infarctions. The FAST-MI 2005 registry

Background Because most randomised trials assessing beta-blocker therapy after acute myocardial infarction (AMI) antedate the era of reperfusion and modern secondary prevention, there are discrepancies among guidelines regarding their use in this setting. We analysed data from the French registry on ST- and non-ST-elevation Myocardial Infarction (FAST-MI) 2005, to assess the impact of early prescription and prolonged beta-blocker therapy after AMI. Methods FAST-MI included 3,670 consecutive patients with AMI throughout France at the end of 2005. Detailed therapy at discharge and over follow-up (5 years) was recorded. We studied associations 1) between beta-blockers at discharge and one-year mortality, 2) between persistence of beta-blocker therapy at one year and 5-year mortality. Cox multivariate analysis and propensity score matching were used. Results Of 2,727 patients with no history of heart failure and no left ventricular dysfunction, 2,168 were prescribed beta-blockers at discharge (80%). One-year mortality was lower in patients on beta-blockers (4.7% vs 12.2%), adjusted hazard ratio 0.76, 0.53-1.10. Among the 1,630 patients discharged on beta-blockers, alive at one year, and with medical prescriptions available, 184 (11%) had stopped beta-blockers. Five-year mortality was 8.8% in patients who continued beta-blockers, versus 13.0% in those who discontinued. Adjusted hazard ratio for 5-year death was 1.01 (0.59-1.73). Propensity score analyses confirmed these findings. Conclusion Our results suggest that discontinuing beta-blockers beyond one year has no deleterious impact, but that early beta-blocker treatment may be beneficial. Until further randomised trials are performed, these data can provide useful information for future recommendations on beta-blocker use after AMI.