Early beta-blocker use may prevent death in patients with acute myocardial injury

Using beta-blockers early can prevent 1-year mortality in patients with acute myocardial injury (AMI), reveals a recent study.

AMI is characterized by elevated cardiac troponin levels with a rising or falling pattern and is associated with an elevated risk of death, according to the investigators who conducted this multicentre, retrospective cohort study using data from the Tianjin Health and Medical Data Platform.

The influence of early beta-blocker use on 1-year all-cause mortality and major adverse cardiovascular events (MACE) in patients with AMI was examined using a new user and target trial emulation design. Propensity score matching was applied. Finally, hazard ratios (HRs) and 95 percent confidence intervals (CIs) were calculated using Cox regression.

Overall, 25,988 participants were included after propensity score matching. Of these, 8,667 were included in the beta-blocker group and 17,299 to the nonbeta-blocker group.

A total of 4,113 deaths (15.8 percent) occurred, while 5,795 (22.3 percent) individuals had MACE. Beta-blocker users showed a significantly lower risk of all-cause mortality (HR, 0.89, 95 percent CI, 0.83‒0.95) and MACE (HR, 0.90, 95 percent CI, 0.85‒0.95) than nonusers. [Am J Med 2025;138:1090-1098.E6]

Subgroup analysis revealed the association of beta-blocker use with a significant reduction in mortality risk among patients without stroke (HR, 0.85, 95 percent CI, 0.78‒0.93). However, no significant association was seen in those with stroke (HR, 1.04, 95 percent CI, 0.91‒1.16).

“In our analysis, we found that beta-blockers are not associated with decreased risk of mortality in patients with stroke,” the investigators said. “This may be because beta-blockers reduce blood pressure during the acute phase, decreasing cerebral blood flow perfusion when permissive hypertension is required.” [Stroke 2019;50:e344-e418]

Another potential reason is that beta-blockers “suppress the normal immune response.” [J Neurol Sci 2016;368:77-83]

Heart function

The current analysis also demonstrated that early use of beta-blockers could prevent death in patients with coronary heart disease.

“This is consistent with current understanding, as it may improve heart function by reducing myocardial oxygen demand, inhibiting excessive sympathetic nervous stimulation, and preventing arrhythmias,” according to the investigators. [J Am Coll Cardiol 2023;81:2299-2311]

“Our results suggest that early use of beta-blockers in patients with myocardial injury combined with coronary heart disease may be a beneficial strategy,” they added.

Beta-adrenergic receptors

Beta-blockers are a class of drugs that selectively bind to beta-adrenergic receptors and thus upset the agonistic effects of neurotransmitters and catecholamines on these receptors. Previous studies have examined its effects on patients with diseases characterized by sympathetic nervous excitation. [Health Technol Assess 2009;13:1-73; Front Cell Infect Microbiol 2023;13:1121444]

“Our analysis is the first to evaluate the effect of early beta-blocker use in patients with AMI,” the investigators said. “It found that beta-blockers are associated with an 11-percent reduction in risk of all-cause mortality, which will provide a reference for clinical decision-making for clinicians to treat patients with AMI.”