SMART-DECISION

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

References

  1. Choi, K. H., Kang, D., Kim, W., Doh, J. H., Kim, J., Park, Y. H., Ahn, S. G., Park, J. P., Kim, S. M., Cho, B. R., Nam, C. W., Shin, E. S., Park, K. W., Han, J. K., Kim, B. K., Gwon, H. C., Kim, H. S., & Hahn, J. Y. (2026). Discontinuation of beta-blocker therapy after myocardial infarction. New England Journal of Medicine, 394(13), 1302–1312. https://doi.org/10.1056/NEJMoa2601005