Beta-blockers are associated with several clinical benefits in patients with reduced left ventricular ejection fraction (REF) after acute myocardial infarction (AMI), such as lower rates of mortality, recurrence of myocardial infarction, and heart failure. However, the long-term prognosis of beta-blockers has rarely been investigated in patients with non-REF after AMI. This study aimed to investigate the clinical benefits of beta-blockers in these patients.The J-MINUET trial is a prognostic study of patients diagnosed with acute myocardial infarction (AMI) based on the new definition.Beta-blockers improved the composite endpoint in AMI patients without reduced left ventricular (LV) dysfunction.Beta-blockers did not affect the incidence of heart failure in patients without LV dysfunction.Beta-blockers act as antiarrhythmic agents and reduce myocardial oxygen demand, which accelerates myocardial necrosis, by controlling heart rate and myocardial contraction during the acute phase of AMI. Beta-blockers are associated with a survival benefit and suppression of left ventricular remodeling in patients with left ventricular dysfunction after AMI.

Therefore, some guidelines strongly recommend the use of beta-blockers in patients with reduced left ventricular ejection fraction (REF) or heart failure after the onset of AMI (class I) including ST-segment elevation myocardial infarction (STEMI) and non-STEMI. However, the benefits of beta-blockers in AMI patients with non-REF after primary PCI are unclear. Therefore, beta-blockers are not strongly recommended for patients without heart failure and with left ventricular ejection fraction >40 % because of a lack of evidence. Recent guidelines recommend the use of cardiac troponin for the diagnosis of AMI. Most previous studies that investigated the efficacy of beta-blockers in patients with AMI did not include non-STEMI patients without creatine kinase (CK) elevation because these patients were treated as unstable angina.

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Mishita
Jornal co-ordinator
Journal of Heart and Cardiovascular Research