ESC 2026: Updates on Post-MI Secondary Prevention and Patient Outcomes

Metoprolol Versus Bisoprolol in Patients with Acute Myocardial Infarction: A Target Trial Emulation Study

Presenter: T Yang

Although β-blockers are recommended after acute myocardial infarction (AMI), comparative evidence between individual agents remains limited. This target trial emulation assessed one-year outcomes with metoprolol versus bisoprolol using real-world electronic health record data from 2013–2022. Hospitalised AMI patients without prior β-blocker use within 180 days or contraindications were analysed using a new-user design and 1:1 propensity score matching; 9,744 patients were included (4,872 per group). Over one year, bisoprolol was associated with higher all-cause mortality than metoprolol (HR 1.35; 95% CI 1.14-1.61; P = 0.001), with consistent findings in per-protocol analysis. The association showed a dose-dependent pattern, with HR 1.64 (95% CI 1.15-2.36; P = 0.007) at >25% to 50% of target dose and HR 4.11 (95% CI 2.00-8.44; P < 0.001) at >50%. Cardiovascular mortality was also higher with bisoprolol (HR 1.31; 95% CI 1.05-1.63; P = 0.016), whereas recurrent MI and stroke did not differ significantly. Thus ,compared with metoprolol, bisoprolol was associated with a higher risk of both all-cause and cardiovascular mortality, with the risk increasing in a dose-dependent manner.

Beta-Blocker Therapy and Sexual Dysfunction after Myocardial Infarction: A Sub-Study of the BETAMI-DANBLOCK Trial

Presenter: J Nyen

Sexual dysfunction is common after myocardial infarction (MI), while the contribution of beta-blocker therapy to these disturbances remains uncertain. A prespecified BETAMI-DANBLOCK analysis examined sexual function in patients with recent MI and LVEF ≥40% randomised to open-label beta-blocker therapy (median metoprolol dose ≥50 mg/day) or no beta-blocker. Among 5,574 trial participants, 2,850 reported sexual activity in the preceding year and 2,332/2,850 (82%) completed at least one sexual-function assessment using IIEF or FSFI at baseline and 3, 12, and 21 months. In men, baseline median IIEF scores were 23 (IQR: 19-24) with beta-blockers and 23 (IQR: 19-25) without; 39% had scores indicating erectile dysfunction. Beta-blockers did not significantly affect total IIEF scores over follow-up, although erectile dysfunction odds were modestly higher at 3 months (OR: 1.58, 95% CI: 1.02, 2.42), with no difference at later assessments. Sildenafil prescription filling was similar in beta-blocker and no beta-blocker group (18% vs 17%). Among women, beta-blocker therapy did not affect FSFI scores, although estimates were uncertain. Overall, the findings indicate a small, transient increase in erectile dysfunction among men without evidence of a sustained effect.

ESC Congress 2026, 28 - 31 Aug, Munich, Germany