Discontinuation of beta-blocker therapy after MI in stable, low-risk patients with LVEF ≥40% and no HF was noninferior to continuing therapy, suggesting long-term beta-blockers may not be necessary in this subgroup.
Study design
- Open-label, randomized, noninferiority trial
- 25 centers
- 2021 to 2024
- N = 2,540
Population
- Prior MI
- On beta-blocker ≥1 year
- LVEF ≥40%
- No HF
- Mean age 63
- 87% male
Interventions
- Discontinue: 1,246
- Continue: 1,294
Primary outcome
- Composite: death, recurrent MI, or HF hospitalization
- Median follow-up 3.1 years
- 7.2% (discontinue) vs 9.0% (continue)
- HR 0.80 (95% CI 0.57–1.13)
- Noninferior
SMART-DECISION
Primary composite endpoint at 3.1 years
7.2% vs 9.0% | HR 0.80
Secondary outcomes
- No difference in individual components
- No difference in AF
- No difference in LV function
- No difference in QoL
- Similar adverse events