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A multicenter open-label randomized noninferiority trial in South Korea assigned stable post–myocardial infarction patients with left ventricular ejection fraction ≥40% and no heart failure to discontinue or continue beta-blockers. The primary composite endpoint was death, recurrent myocardial infarction, or heart-failure hospitalization.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/discontinuation-of-beta-blocker-therapy-after-myocardial-infarction-original-article/484799/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/discontinuation-of-beta-blocker-therapy-after-myocardial-infarction-original-article/484799.png","ImageObject",300,407,{"name":92,"@type":93},"Liam","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What patient population was studied in this trial?","Question",{"text":112,"@type":113},"Stable patients after myocardial infarction with left ventricular ejection fraction of at least 40% and no heart failure were included.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What was the primary endpoint used to compare the groups?",{"text":117,"@type":113},"The primary endpoint was a composite of death from any cause, recurrent myocardial infarction, or hospitalization for heart failure.",{"name":119,"@type":110,"acceptedAnswer":120},"How did discontinuation compare with continuation of beta-blocker therapy?",{"text":121,"@type":113},"Discontinuation was noninferior to continuation with respect to the composite endpoint.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},484799,1791163456,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},8796095461564,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","The new e ngla nd jou r na l of m e dicine  \nOriginal Article  \nDiscontinuation of Beta-Blocker Therapy after Myocardial Infarction  \nK. H. Choi,1 D. Kang,2 W. Kim,3 J.-H. Doh,4 Juhan Kim,5 Y. H. Park,6 S.G. Ahn,7  \nJ. P. Park,8 S. M. Kim,9 B. R. Cho,10 C.-W. Nam,11 J. H. Cho,12 S.-J. Joo,13 J. Suh,14 J.-O. Jeong,15 W.J. Jang,16 C.W. Goh,17 C.-H. Yoon,18 J.-Y. Hwang,19 S.-H. Lim,20  \nS. R. Lee,21 E.-S. Shin,22 B.J. Kim,23 C.W. Yu,24 S.-H. Her,25 H. K. Kim,26 K.T. Park,27 Juwon Kim,1 Jihoon Kim,1 T. K. Park,1 J. M. Lee,1 J. Cho,2 J. H. Yang,1 Y. B. Song,1  \nS.-H. Choi,1 H.-C. Gwon,1 E. Guallar,28 and J.-Y. Hahn,1 for the SMART-DECISION Investigators*  \nA BST RACT  \nBACKGROUND  \nThe role of long-term beta-blocker therapy after a myocardial infarction in patients without left ventricular systolic dysfunction or heart failure is unclear in the era of contemporary coronary-artery reperfusion and secondary prevention interventions.  \nMETHODS  \nWe conducted an open-label, randomized, noninferiority trial at 25 centers in South Korea. Patients whose condition remained stable after a myocardial infarction, who had a left ventricular ejection fraction of at least 40% and no heart failure, and who had received beta-blocker therapy for at least 1 year after the myocardial infarction were randomly assigned in a 1:1 ratio to discontinue or to continue betablocker therapy. The primary end point was a composite of death from any cause, recurrent myocardial infarction, or hospitalization for heart failure. The prespecified noninferiority margin was an upper limit of the 95% confidence interval for the hazard ratio of 1.4.  \nRESULTS  \nA total of 2540 patients underwent randomization; 1246 were assigned to betablocker discontinuation and 1294 to beta-blocker continuation. The mean age of the patients was 63.2 years, and 12.8% were women. At a median follow-up of 3.1 years (interquartile range, 2.5 to 3.5), a primary end-point event had occurred in 58 patients (4-year Kaplan–Meier estimate, 7.2%) in the discontinuation group and in 74 patients (4-year Kaplan–Meier estimate, 9.0%) in the continuation group (hazard ratio, 0.80; 95% confidence interval, 0.57 to 1.13; P = 0.001 for noninferiority). The incidence of serious adverse events was similar in the two groups.  \nCONCLUSIONS  \nAmong patients who received beta-blocker therapy beyond the first year after a myocardial infarction, discontinuation of beta-blocker therapy was noninferior to continuation with respect to a composite of death from any cause, recurrent myocardial infarction, or hospitalization for heart failure. (Funded by Patient-Centered Clinical Research Coordinating Center in the Ministry of Health and Welfare, South Korea; SMART-DECISION [ClinicalTrials.gov](ClinicalTrials.gov) number, NCT04769362.)  \nThe authors’ full names, academic degrees, and affiliations are listed at the end of the article. Joo-Yong Hahn can be contacted at [jyhahn@skku.edu](jyhahn@skku.edu) or at the Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, South Korea. Weon Kim can be contacted at mylovekw@ hanmail. net or at the Department of Cardiovascular Medicine, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, South Korea.  \n*A list of the SMART-DECISION investigators is provided in the Supplementary Appendix, available [at NEJM.org](at NEJM.org).  \nKi Hong Choi and Danbee Kang, and Weon Kim and Joo-Yong Hahn, contributed equally to this article.  \nThis article was published on March 30, 2026, [at NEJM.org](at NEJM.org).  \nDOI: 10.1056/NEJMoa2601005  \nCopyright © 2026 Massachusetts Medical Society.  \nn eng l j med  \n[nej m.org](nej m.org)  \n1  \nThe new e ngla nd jou r na l of m e dicine  \nThe role of beta-blockers after an  \nacute myocardial infarction is being rede  \nfined in the contemporary era of early revascularization and comprehensive secondary prevention.1 In patients with heart fail","cbCaivQSo8hxlxlC","https://ap.wps.com/l/cbCaivQSo8hxlxlC","pdf",403663,11,"English","# Background\n# Methods\n# Results\n# Conclusions","[{\"question\":\"What patient population was studied in this trial?\",\"answer\":\"Stable patients after myocardial infarction with left ventricular ejection fraction of at least 40% and no heart failure were included.\"},{\"question\":\"What was the primary endpoint used to compare the groups?\",\"answer\":\"The primary endpoint was a composite of death from any cause, recurrent myocardial infarction, or hospitalization for heart failure.\"},{\"question\":\"How did discontinuation compare with continuation of beta-blocker therapy?\",\"answer\":\"Discontinuation was noninferior to continuation with respect to the composite endpoint.\"}]","Discontinuation of Beta-Blocker Therapy after Myocardial Infarction - Original Article | PDF",1790803094,28]