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.
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.
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.