Why does this matter?
Does the choice of β-blocker influence outcomes after myocardial infarction (MI) in patients without heart failure? This study compared atenolol with bisoprolol, rather than testing whether β-blockers should be prescribed at all.
How was the study conducted?
Using the French National Health Data System, investigators identified 11,558 adults hospitalised with a new MI in the Paris area between 2008 and 2018. Patients started atenolol or bisoprolol within two days of discharge and were followed for up to two years.
Patients with recorded heart failure, β-blocker prescriptions or loop-diuretic prescriptions during the two years before discharge were excluded.
The primary outcome was major adverse cardiovascular events (MACE): cardiac arrest, all-cause mortality, reinfarction, stroke or hospitalisation for heart failure.
What were the results?
Weighted outcome proportions over two years
| Outcome | Atenolol | Bisoprolol |
|---|---|---|
| Major adverse cardiovascular events | 10.8% | 14.1% |
| All-cause mortality | 1.4% | 2.2% |
The reported average treatment effect for MACE was 2.9 percentage points favouring atenolol (95% CI 1.1–4.7).
For mortality, the reported effect was 0.6 percentage points (95% CI −0.2 to 1.3). Because the confidence interval included no difference, a survival advantage was not established.
The weighted proportions and average treatment effects are reported separately as presented in the abstract; direct subtraction of the proportions does not reproduce the reported treatment-effect estimates.
Should this change prescribing?
Not on its own. Treatment was not randomised, so differences between patients receiving the two drugs could have influenced the findings despite statistical adjustment.
Importantly, “without recorded heart failure” does not confirm preserved left ventricular ejection fraction. The abstract does not provide an echocardiographic eligibility threshold.
The study also did not test switching from bisoprolol to atenolol, compare either drug with no β-blocker, or establish the optimal dose or treatment duration.
Clinical takeaway
Atenolol was associated with fewer cardiovascular events than bisoprolol in this selected post-MI population. The findings raise an important question about β-blocker choice, but do not establish causal superiority or justify routine switching.
Reference: Laurenceau T, et al. Atenolol or Bisoprolol after Myocardial Infarction without Recorded Heart Failure. NEJM Evidence. 2026. doi:10.1056/EVIDoa2600138.
Based on the supplied abstract; the full article was not available for detailed appraisal.