Association of the medical therapy with beta-blockers or inhibitors of renin-angiotensin system with clinical outcomes in patients with mildly reduced left ventricular ejection fraction after acute myocardial infarction

In the era of the initial optimal interventional and medical therapy for acute myocardial infarction (AMI), a number of patients with mildly reduced left ventricular ejection fraction (EF) (41%.49%) have been increasing. This observational study aimed to investigate the association between the medical therapy with oral beta-blockers or inhibitors of renin-angiotensin system (RAS) and 2-year clinical outcomes in patients with mildly reduced EF after AMI. Among patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health, propensity-score matched patients who survived the initial attack and had mildly reduced EF were selected according to beta-blocker or RAS inhibitor therapy at discharge. Beta-blocker therapy at discharge was associated with lower 2-year major adverse cardiac events which was a composite of cardiac death, myocardial infarction, revascularization and re-hospitalization due to heart failure (8.7 vs 12.8/100 patient-years; hazard ratio [HR] 0.68; 95% confidence interval [CI] 0.50.0.93; P = .015), and no significant interaction between EF ≤45% and > 45% was observed (P_interaction= 0.354). This association was mainly driven by lower myocardial infarction in patients with beta-blockers (HR 0.50; 95% CI 0.26.0.95; P = .035). Inhibitors of RAS at discharge were associated with lower re-hospitalization due to heart failure (1.8 vs 3.5/100 patient-years; HR 0.53; 95% CI 0.33. 0.86; P = .010) without a significant interaction between EF ≤45% and > 45% (P_interaction= 0.333). In patients with mildly reduced EF after AMI, the medical therapy with beta-blockers or RAS inhibitors at discharge was associated with better 2-year clinical outcomes. Abbreviations: ACEi = angiotensin-converting enzyme inhibitors, AMI = acute myocardial infarction, ARB = angiotensin receptor blockers, BMI = body mass index, CAD = coronary artery disease, CI = confidence interval, EF = ejection fraction, eGFR = estimated glomerular filtration rate, HFmrEF = heart failure with mildly reduced ejection fraction, HFpEF = heart failure with preserved ejection fraction, HFrEF = heart failure with reduced ejection fraction, HR = hazard ratio, LV = left ventricular, MACE = major adverse cardiac events, PCI = percutaneous coronary intervention, RAS = renin-angiotensin system, STEMI = ST-elevation myocardial infarction.