Beta-blockers after acute coronary syndrome: insights across the ejection fraction spectrum
Abstract
Aims: To evaluate the association between beta-blocker (BB) prescription and long-term all-cause mortality after acute coronary syndrome (ACS), and to assess whether this varies across the left ventricular ejection fraction (LVEF) spectrum.
Methods and results: We analysed ACS patients from the retrospective multicentre CardioMining study (NCT05176769). The primary analysis used inverse probability of treatment weighting (IPTW) and restricted mean survival time (RMST) derived from weighted Kaplan–Meier curves. RMST and survival differences were estimated at 1 and 5 years. A landmark analysis evaluated survival between years 1 and 5 among first-year survivors. Among 6049 ACS patients (age 66.8 ± 13.2 years; 74.9% male), 5107 (84.4%) were discharged on BBs. During a median 4.6-year follow-up, 1912 deaths (31.6%) occurred. Overall, the 1-year RMST difference associated with BBs was 6.3 days (95%CI 0.0 to 13.2), which attenuated further by 5 years (11.3 days, 95%CI −30.7 to 63.9). The largest 1-year RMST difference was observed among patients with LVEF ≤40% (18.8 days, 95%CI 1.1 to 37.4), whereas associations were smaller and non-significant among patients with LVEF 41–49% and LVEF ≥50%. At 5 years, confidence intervals crossed the null across all LVEF categories. Continuous LVEF analyses suggested greater short-term benefit at lower values, with progressive attenuation across the LVEF spectrum. Among 1-year survivors, no significant RMST differences were observed between years 1 and 5.
Conclusion: Discharge BB prescription was not associated with a clear long-term survival advantage after ACS in this large real-world cohort. Apparent associations were strongest at lower LVEF values and attenuated during longer follow-up.
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BibTeX
@article{tsiartas2026betablockers,
title = {{Beta-blockers after acute coronary syndrome: insights across the ejection fraction spectrum}},
author = {Eirinaios Tsiartas and Sokratis Oikonomou and Aristea Iordanidou and Athanasios Samaras and Andreas S Papazoglou and Dimitrios V Moysidis and Vassileios Vassilikos and Antonios Ziakas and Periklis Davlouros and Konstantinos Tsioufis and Dimitrios N Tziakas and Ioannis Zarifis and George Giannakoulas},
journal = {European Heart Journal Open},
year = {2026},
month = oct,
doi = {10.1093/ehjopen/oeag175},
url = {https://doi.org/10.1093/ehjopen/oeag175},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Beta-blockers after acute coronary syndrome: insights across the ejection fraction spectrum
AU - Eirinaios Tsiartas
AU - Sokratis Oikonomou
AU - Aristea Iordanidou
AU - Athanasios Samaras
AU - Andreas S Papazoglou
AU - Dimitrios V Moysidis
AU - Vassileios Vassilikos
AU - Antonios Ziakas
AU - Periklis Davlouros
AU - Konstantinos Tsioufis
AU - Dimitrios N Tziakas
AU - Ioannis Zarifis
AU - George Giannakoulas
PY - 2026
DA - 2026/10/14
JO - European Heart Journal Open
DO - 10.1093/ehjopen/oeag175
UR - https://doi.org/10.1093/ehjopen/oeag175
AB - Aims: To evaluate the association between beta-blocker (BB) prescription and long-term all-cause mortality after acute coronary syndrome (ACS), and to assess whether this varies across the left ventricular ejection fraction (LVEF) spectrum. Methods and results: We analysed ACS patients from the retrospective multicentre CardioMining study (NCT05176769). The primary analysis used inverse probability of treatment weighting (IPTW) and restricted mean survival time (RMST) derived from weighted Kaplan–Meier curves. RMST and survival differences were estimated at 1 and 5 years. A landmark analysis evaluated survival between years 1 and 5 among first-year survivors. Among 6049 ACS patients (age 66.8 ± 13.2 years; 74.9% male), 5107 (84.4%) were discharged on BBs. During a median 4.6-year follow-up, 1912 deaths (31.6%) occurred. Overall, the 1-year RMST difference associated with BBs was 6.3 days (95%CI 0.0 to 13.2), which attenuated further by 5 years (11.3 days, 95%CI −30.7 to 63.9). The largest 1-year RMST difference was observed among patients with LVEF ≤40% (18.8 days, 95%CI 1.1 to 37.4), whereas associations were smaller and non-significant among patients with LVEF 41–49% and LVEF ≥50%. At 5 years, confidence intervals crossed the null across all LVEF categories. Continuous LVEF analyses suggested greater short-term benefit at lower values, with progressive attenuation across the LVEF spectrum. Among 1-year survivors, no significant RMST differences were observed between years 1 and 5. Conclusion: Discharge BB prescription was not associated with a clear long-term survival advantage after ACS in this large real-world cohort. Apparent associations were strongest at lower LVEF values and attenuated during longer follow-up.
SN - 2752-4191
ER -