"Myocardial infarction patients no longer need one unnecessary drug"... International joint study eases patient burden [Health Check]

[Financial News] A joint study by researchers in Korea and France involving 6,238 myocardial infarction patients found no statistically significant difference in the 3-year incidence of major cardiovascular events between the group that stopped taking beta-blockers and the group that continued them, at 17.2% and 15.9%, respectively.
Beta-blockers slow the heart rate and lower blood pressure, easing the heart's workload for myocardial infarction patients. Until now, it has generally been standard for these patients to take the medication for life.
A research team led by Professors Han Ju-yong and Choi Ki-hong of the Department of Cardiology at Samsung Seoul Hospital, along with Professor Kang Dan-bi of the Clinical Epidemiology Research Center, published the findings in the latest issue of The Lancet, one of the world's most prestigious medical journals, in collaboration with Professor Joan Sylvain's team at Pitié-Salpêtrière University Hospital under the Assistance Publique-Hôpitaux de Paris, Europe's largest hospital group.
Assistance Publique-Hôpitaux de Paris is Europe's largest hospital network, with 38 hospitals and partnerships with six university hospital groups, including Sorbonne University.
The team conducted a pooled analysis of randomized studies carried out in Korea (SMART-DECISION) and France (ABYSS). The results once again confirmed that patients who had reached a stable phase after treatment for myocardial infarction did not experience more health problems when they stopped taking beta-blockers than when they continued.
Although previous studies were large, they fell short of becoming a global standard because of limitations in race, region, and analytical methods. In this case, researchers in Korea and France joined forces to produce these results.
The team analyzed 6,238 patients who were six months past their myocardial infarction and had no other reason to take beta-blockers or no heart function problems such as heart failure. They divided them into a discontinuation group of 3,092 and a continuation group of 3,146, then followed them for three years.
Cases meeting the primary endpoint, defined as death from any cause, myocardial infarction, stroke, or cardiovascular-related hospitalization, occurred in 17.2% of the discontinuation group and 15.9% of the continuation group, showing statistical equivalence.
For the secondary endpoint, defined as death from any cause, myocardial infarction, or hospitalization for heart failure, there was also no significant difference, at 6.5% in the discontinuation group and 6.4% in the continuation group, the researchers said.
As the first author, Professor Choi Ki-hong emphasized the significance of the study, saying, "In the past, because treatment for myocardial infarction was not easy, it was important to take beta-blockers for life." He added, "With improved treatments such as stents, more patients now recover heart function and become stable after myocardial infarction. If we can stop unnecessary drugs for these patients, we can also reduce their burden."
In March, the Samsung Seoul Hospital research team also drew global attention by publishing findings in the New England Journal of Medicine (NEJM) showing that beta-blockers can be discontinued when heart function is stable after myocardial infarction.
That study was based on randomized clinical results from 25 hospitals in Korea and sparked discussion in the academic community about revisiting beta-blocker prescribing standards that had become entrenched practice for decades. It was also selected as the "most notable clinical study" at the American College of Cardiology (ACC) annual meeting held in March.
The SMART-DECISION study is an investigator-initiated clinical trial led by Professor Han Ju-yong over five years in collaboration with the Korean Society of Myocardial Infarction after being selected in 2021 as a state-funded project under the Ministry of Health and Welfare's patient-centered medical technology optimization research program.
This new study conducted with France has further increased the possibility of changing global treatment guidelines for myocardial infarction related to beta-blocker use. Because it represents a new milestone led by Korean medical researchers, based on studies previously centered on the West, including the United States and Europe, its significance is substantial.
The European Society of Cardiology also named the Korea-France joint study one of the most notable clinical studies at its annual congress held on August 30 in Munich, Germany.
Professor Han Ju-yong said, "Through this large-scale international joint study, we have moved one step closer to establishing a treatment standard that says beta-blockers can be stopped if a patient is stable after myocardial infarction." He added, "I am pleased that this has drawn attention not only in Korea but around the world, and I also feel a heavy sense of responsibility. I hope this becomes an opportunity to build a culture in which drugs are used only for patients who truly need them, based on rational and scientific standards."
 


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