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ST-Segment Elevation Myocardial Infarction Patients in the Coronary Care Unit Is it Time to Break Old Habits? Long-Term Outcomes of Biodegradable Versus Second-Generation Durable Polymer Drug-Eluting Stent Implantations for Myocardial Infarction Canadian Multicenter Chronic Total Occlusion Registry: Ten-Year Follow-Up Results of Chronic Total Occlusion Revascularization Position paper of the EACVI and EANM on artificial intelligence applications in multimodality cardiovascular imaging using SPECT/CT, PET/CT, and cardiac CT 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC) Mortality 10 Years After Percutaneous or Surgical Revascularization in Patients With Total Coronary Artery Occlusions Randomized Comparison of Ridaforolimus-Eluting and Zotarolimus-Eluting Coronary Stents 2-Year Clinical Outcomes: From the BIONICS and NIREUS Trials Right ventricular stroke work correlates with outcomes in pediatric pulmonary arterial hypertension The spectrum of chronic coronary syndromes: genetics, imaging, and management after PCI and CABG Drug-coated balloons for small coronary artery disease (BASKET-SMALL 2): an open-label randomised non-inferiority trial

Review ArticleVolume 74, Issue 5, August 2019

JOURNAL:J Am Coll Cardiol. Article Link

The Evolution of β-Blockers in Coronary Artery Disease and Heart Failure (Part 1/5)

P Joseph, K Swedberg, DP Leong et al. Keywords: heart failure; HF following ACS; stable CAD; β-blocker;

ABSTRACT


As new treatments continue to improve clinical outcomes in coronary artery disease (CAD) and heart failure, it is necessary to characterize the appropriate use of β-adrenergic receptor blockers (β-blockers) in the contemporary management of these conditions. This review examines the current evidence supporting β-blocker use in heart failure with preserved ejection fraction (HFpEF), heart failure with midrange ejection fraction (HFmEF), and heart failure with reduced ejection fraction (HFrEF), following acute coronary syndrome and in stable CAD. β-Blockers remain essential in the treatment of HFrEF, but limited evidence supports their use in HFmEF or HFpEF. They should still be considered routinely following acute coronary syndrome, but there is a need for contemporary trials that re-examine this in patients without left ventricular dysfunction, as well as in patients with stable CAD. From a global perspective, more studies are needed to characterize the extent of β-blocker use in CAD and heart failure, and how evidence-based use can be improved in these conditions.