ESC®️ 2025 – BETAMI–DANBLOCK: Beta-blockers after infarction?

At ESC®️ 2025, Dr. Dan Atar presented the results of the BETAMI–DANBLOCK clinical trial, published simultaneously in the New England Journal of Medicine (NEJM). The central question addressed was whether beta-blockers, whose historical indication is supported by studies from the pre-revascularization era, still offer clinical benefit in post-myocardial infarction (AMI) patients with preserved or slightly reduced ejection fraction.

The study combined two large trials conducted in Denmark and Norway, involving 5,574 patients with AMI and ejection fraction ≥40%, randomized to beta-blockers or not within 14 days of the event. After a median follow-up of 3.5 years, the primary composite endpoint—death from any cause or major cardiovascular events (new AMI, unplanned revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmias)—occurred in 14.2% of patients using beta-blockers versus 16.3% in the

control group (HR 0.85; 95%CI 0.75–0.98; p=0.03). The benefit was especially driven by the reduction in new infarctions (5.0% vs. 6.7%; HR 0.73; 95%CI 0.59–0.92).

In the interview, Atar pointed out that contemporary practice — marked by early revascularization, routine use of dual antiplatelet therapy and statins — had led many clinicians to question the need to maintain beta-blockers after AMI. However, according to the author, the findings "reignite the discussion" and demonstrate that, even in a modern setting, these agents still reduce relevant cardiovascular events. He noted that the analysis also included patients with slightly reduced ejection fraction (40–49%), a subgroup of special interest, although the study was not designed to draw definitive conclusions in this stratum.

The trial showed safety, with no significant increase in serious adverse events. Although there was no difference in mortality alone, the results consolidate the idea that beta-blockers continue to play a protective role in post-AMI, even in patients without established heart failure.

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