Table 1.
Oral beta-blocker therapy in the guidelines for the management of patients with acute myocardial infarction
| Guidelines | Class | LOE |
|---|---|---|
| Guidelines for the management of patients with STEMI | ||
| 1. 2013 ACC/AHA guideline [15] | ||
| Recommendations | ||
| · Oral beta-blockers should be initiated in the first 24 hours in patients with STEMI who do not have any of the following: signs of HF, evidence of a low output state, increased risk for cardiogenic shock, or other contraindications to use of oral beta blockers (PR interval more than 0.24 seconds, second- or third-degree heart block, active asthma, or reactive airways disease). | I | B |
| · Beta-blockers should be continued during and after hospitalization for all patients with STEMI and with no contraindications to their use. | I | B |
| 2. 2017 ESC guidelines [16] | ||
| Recommendations | ||
| · Oral treatment with beta-blockers is indicated in patients with HF and/or LVEF ≤40% unless contraindicated. | I | A |
| · Routine oral treatment with beta-blockers should be considered during hospital stay and continued thereafter in all patients without contraindications. | IIa | B |
| Guidelines for the management of patients with NSTEMI | ||
| 1. 2014 AHA/ACC guideline [17] | ||
| Recommendations | ||
| · Oral beta-blocker therapy should be initiated within the first 24 hours in patients who do not have any of the following: (1) signs of HF, (2) evidence of low-output state, (3) increased risk for cardiogenic shock, or (4) other contraindications to beta-blockade (e.g., PR interval >0.24 second, second- or third-degree heart block without a cardiac pacemaker, active asthma, or reactive airway disease). | I | A |
| · In patients with concomitant NSTE-ACS, stabilized HF, and reduced systolic function, it is recommended to continue beta-blocker therapy with 1 of the 3 drugs proven to reduce mortality in patients with HF: sustained-release metoprolol succinate, carvedilol, or bisoprolol. | I | C |
| · It is reasonable to continue beta-blocker therapy in patients with normal LV function with NSTE-ACS. | IIa | C |
| 2. 2020 ESC guidelines [18] | ||
| Recommendations | ||
| · Early initiation of beta-blocker treatment is recommended in patients with ongoing ischemic symptoms and without contraindications to the respective drug class. It is recommended to continue chronic beta-blocker therapy unless the patient is in Killip class III or higher. | I | C |
| · Long-term beta-blockers are recommended in patients with systolic LV dysfunction or HF with reduced LVEF (<40%). | I | A |
| · In patients with prior MI, long-term oral treatment with a beta-blocker should be considered in order to reduce all-cause and cardiovascular mortality and cardiovascular morbidity | IIa | B |
LOE: level of evidence; STEMI: ST-elevation myocardial infarction; ACC: American College of Cardiology; AHA: American Heart Association; HF: heart failure; ESC: European Society of Cardiology; LVEF: left ventricular ejection fraction; NSTEMI; non-ST-elevation myocardial infarction; NSTE-ACS: non-ST-elevation-acute coronary syndrome; LV: left ventricular; MI: myocardial infarction.