β-Blocker Therapy Post-MI May Be Safely Discontinued in Very Stable Patients

Background: Recently, the routine use of β-blockers post-myocardial infarction (MI) has been questioned, especially in stable patients with a left ventricular ejection fraction (LVEF) ≥50%. Recent trials have demonstrated mixed results. Objective: To ascertain if stopping β-blocker therapy in stable patients post-MI would be noninferior to continuation of β-blocker regarding major cardiovascular outcomes. Design: Open-label, randomized, noninferiority (SMART-DECISION [Smart Angioplasty Research Team: Decision on Medical Therapy in Patients with Coronary Artery Disease or Structural Heart Disease Undergoing Intervention]) trial conducted in 25 South Korean centers. Participants/Methods: Stable patients post-MI who received a β-blocker for at least 1 year after the index MI and were clinically stable were eligible. Key exclusion criteria were treatment for heart failure, LVEF <40%, contraindication for β-blocker therapy, or atrial fibrillation. The primary end point was a composite more...