Chronological Aging and Progression of Coronary Artery Disease: Insights from Pooled IVUS Trials of Lipid-Lowering Therapies

Presenter: Abdulla Damluji

This pooled analysis of five randomized IVUS trials (REVERSAL, ASTEROID, SATURN, ILLUSTRATE [atorvastatin arm], and GLAGOV [evolocumab arm]) evaluated whether chronological age influences response to intensive lipid-lowering therapy in coronary atherosclerosis. A total of 2,242 patients (mean age 61 years; 29% female) were included, with outcomes assessed over 18–24 months. Baseline percent atheroma volume (PAV) was similar across age groups (50–60, 61–70, >70 years), while total atheroma volume increased with age. Older patients had higher prevalence of hypertension and atrial fibrillation but lower baseline LDL-C and similar CRP levels.

After adjustment, there was no significant difference in annualized change in PAV across age groups: -0.12±0.27% (50–60), -0.10±0.27% (61–70), and -0.03±0.28% (>70) (p=0.50).

Overall, chronological age did not influence coronary plaque regression with statins or PCSK9 inhibitors, suggesting age alone should not limit use of intensive lipid-lowering therapy in older adults at high cardiovascular risk.

The Use of Beta-Blockers After Myocardial Infarction in Patients with Left Ventricular Ejection Fraction of More Than 40%: A Meta-Analysis

Presenter: Ahmad Al-Abdouh

This meta-analysis of randomized controlled trials evaluated the effects of beta-blocker therapy in patients with myocardial infarction (MI) and left ventricular ejection fraction (LVEF) >40%. Literature from PubMed, Google Scholar, and ClinicalTrials.gov up to September 2025 was included, with a median follow-up of 3.5 years.

Beta-blocker use was associated with a statistically significant increase in cardiovascular mortality (RR 1.19; 95% CI: 1.06–1.32). However, there were no significant differences in all-cause mortality (RR 0.99; 95% CI: 0.91–1.08), recurrent MI (RR 0.90; 95% CI: 0.74–1.09), ischemic stroke (RR 1.14; 95% CI: 0.78–1.65), or hospitalization for heart failure (RR 0.93; 95% CI: 0.64–1.35).

Overall, beta-blockers were associated with increased cardiovascular mortality without benefit in other clinical outcomes in this population.

SGLT2 Inhibitors and Post-Myocardial Infarction Outcomes in Type 2 Diabetes: A Meta-Analysis

Presenter: Nischal Sharma

This meta-analysis evaluated the efficacy of SGLT2 inhibitors (SGLT2i) on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus (T2DM) following myocardial infarction (MI). A total of 12 studies (2016–2024) including 34,672 patients were analyzed. SGLT2i therapy significantly reduced major adverse cardiovascular events (MACE) (HR 0.82; 95% CI: 0.74–0.90; p<0.001), heart failure hospitalizations (HR 0.73; 95% CI: 0.65–0.82; p<0.001), and progression of renal disease (HR 0.76; 95% CI: 0.66–0.88; p<0.001). All-cause mortality showed a non-significant trend toward reduction (HR 0.88; 95% CI: 0.76–1.02; p=0.09).

Funnel plot analysis suggested minimal publication bias.

Overall, SGLT2i demonstrated consistent cardiovascular and renal benefits in post-MI diabetic patients.

Early Versus Delayed Initiation of SGLT2 Inhibitors After Myocardial Infarction in HFPF: Insights From a Nationwide Propensity-Matched Cohort Analysis

Presenter: Talal Almas

This retrospective cohort study using the TriNetX database evaluated the impact of early versus delayed or no initiation of SGLT2 inhibitors (SGLT2i) in patients with heart failure with preserved ejection fraction (HFpEF) following myocardial infarction (MI). Adults with LVEF >40% were included, with 1:1 propensity matching yielding 5,466 patients in each group. Early SGLT2i initiation (within 30 days) was associated with significantly lower mortality (17.6% vs 39.7%; HR 0.66; 95% CI: 0.61–0.71; p<0.001). Stroke risk was reduced (4.5% vs 8.6%; HR 0.53; p<0.001), as were other major adverse cardiovascular events (MACE) (5.2% vs 10.0%; HR 0.51; p<0.001). Heart failure exacerbations were also lower (42.2% vs 65.8%; HR 0.64; p<0.001).

The composite outcome of death or MACE favored early initiation (22.1% vs 45.5%; HR 0.59; 95% CI: 0.55–0.64; p<0.001). Atrial fibrillation incidence showed a non-significant trend toward reduction.

Overall, early SGLT2i initiation after MI in patients with HFpEF was associated with lower mortality, stroke, MACE, HF exacerbations, and a lower composite of death or MACE compared to delayed or no therapy.

Long-Term Beta Blockers in Post-Myocardial Infarction Patients with Preserved Ejection Fraction: An Updated Meta-Analysis of 74,907 Patients

Presenter: Imad Samman Tahhan

This updated meta-analysis evaluated the long-term efficacy of beta-blockers (BBs) in post–myocardial infarction (MI) patients with preserved ejection fraction (EF ≥50%). Fifteen studies (3 RCTs and 12 observational) including 74,907 patients (mean EF 53.1%, mean age 63.8 years) were analyzed. BB use was associated with reduced all-cause mortality at 1 year (RR 0.76; 95% CI: 0.69–0.83), 2 years (RR 0.78; 95% CI: 0.68–0.89), and 3 years (RR 0.82; 95% CI: 0.78–0.88). However, this benefit was primarily driven by observational studies, while RCTs showed no significant mortality reduction.

Cardiovascular mortality was not significantly reduced overall (RR 0.75; 95% CI: 0.54–1.04; p=0.08), though observational studies showed benefit (RR 0.60; p=0.02). There were no significant differences in major adverse cardiovascular events (MACE), recurrent MI, stroke, or heart failure hospitalization.

Overall, BBs were associated with lower all-cause mortality, largely driven by observational data, with no significant benefit in other outcomes.

Beta-Blockers After Myocardial Infarction without Reduced Ejection Fraction (LVEF>40%): A Meta-Analysis of Randomized Trials

Presenter: Sangho Hyun, MD

This PRISMA-guided meta-analysis evaluated the benefit of beta-blockers in post–myocardial infarction (MI) patients with left ventricular ejection fraction (LVEF) >40% in the contemporary reperfusion era. Five randomized controlled trials (REBOOT, BETAMI, DANBLOCK, REDUCE-AMI, CAPITAL-RCT; n=19,826) were included. Beta-blockers were not associated with reduced all-cause mortality (397/9,892 vs 404/9,934; HR 0.98; 95% CI: 0.85–1.13; I²=0%). There was no significant effect on recurrent MI (HR 0.88; 95% CI: 0.74–1.05; I²=32%) or heart failure hospitalization (HR 0.82; 95% CI: 0.63–1.07; I²=0%). Results were consistent across analyses, including fixed-effects models and exclusion of STEMI-only trials.No interaction was observed across EF subgroups (40–49% vs ≥50%). Serious bradyarrhythmias were not increased (HR 1.05; 95% CI: 0.83–1.33; I²=0%).

Routine beta-blocker use did not improve outcomes in post-MI patients with preserved or mildly reduced EF.

Impact of Complete Versus Incomplete Guideline-Directed Medical Therapy on Functional Recovery After Myocardial Infarction in Elderly Patients With HFREF in a Peruvian Cohort

Presenter: Gina L. Sanchez-Sanchez

This retrospective cohort study evaluated the impact of complete guideline-directed medical therapy (GDMT), including SGLT2 inhibitors, in elderly patients with heart failure with reduced ejection fraction (HFrEF) three months after myocardial infarction (MI). A total of 150 patients treated in a national referral hospital in Peru (2022–2023) were included, with 50 (33%) receiving complete GDMT and the remainder receiving GDMT without SGLT2i. Patients receiving complete GDMT were younger (64.8 ± 4.2 vs 70.4 ± 6.5 years; p<0.001), with similar baseline NYHA class and risk factors. At 6 months, 38% of patients on complete GDMT were in NYHA class I compared to 0% in the incomplete group (p<0.001). At 12 months, 100% of the complete GDMT group remained in class I versus 98% of the incomplete group in class II–III (p<0.001).

Baseline LVEF was similar between groups but improved significantly more with complete GDMT at 6 months (0.45 vs 0.40; p<0.001) and 12 months (0.48 vs 0.40; p<0.001).

Overall, complete GDMT including SGLT2i was associated with better functional status and greater improvement in LVEF.

Sex-Based Differences in Outcomes of Ventricular Arrhythmias Following Acute Myocardial Infarction: A Propensity-Matched Analysis

Presenter: Abhigan Shrestha,

This retrospective cohort study using the TriNetX Global Network evaluated sex-based differences in outcomes among patients with ventricular arrhythmias following acute myocardial infarction (AMI). After 1:1 propensity score matching, 153,816 patients were included in each group, balanced for demographics and comorbidities, with outcomes assessed at 1 year. All-cause mortality was comparable between males and females. However, significant differences were observed in secondary outcomes. Males had higher rates of cardiac arrest, cardiogenic shock, and cardiac ablation, whereas females had a higher risk of stroke.

Overall, while mortality did not differ by sex, important differences in cardiovascular complications were observed between males and females following ventricular arrhythmias after AMI.

Efficacy and Safety of Beta-Blockers After Myocardial Infarction with Heart Failure: An Updated Systematic Review and Meta-Analysis

Presenter: Mahmoud Mohamed Elshafey Shams

This systematic review of randomized controlled trials evaluated the long-term benefits of beta-blockers (BB) in patients with recent myocardial infarction (MI) and preserved ejection fraction (EF). Four RCTs (n=19,826; 9,892 BB vs 9,934 control) were included. There was no significant difference in the primary outcome of major adverse cardiovascular events (MACE) between groups (OR 0.92; 95% CI: 0.82–1.04; p=0.202). However, subgroup analysis showed a significant reduction in MACE among patients with mildly reduced EF (40–49%) (OR 0.73; 95% CI: 0.56–0.95; p=0.0189).

No significant differences were observed in all-cause mortality (OR 0.98; p=0.8377), cardiovascular death (OR 1.16; p=0.995), recurrent MI (OR 0.88; p=0.222), or revascularization (OR 1.01; p=0.92).

Overall, BBs did not improve outcomes in patients with preserved EF but may benefit those with mildly reduced EF.

Beta-Blockers After Myocardial Infarction in Patients Without Reduced Ejection Fraction: A Meta-Analysis of Randomized Controlled Trials

Presenter: Mrinal Murali Krishna,

This meta-analysis evaluated the efficacy of beta-blocker (BB) therapy in patients with myocardial infarction (MI) and ejection fraction (EF) ≥40%. Five randomized controlled trials including 23,524 patients (11,744 on BB therapy) were analyzed. BB therapy was associated with a modest reduction in composite cardiovascular endpoints (CCE) compared to no BB therapy (RR 0.92; 95% CI: 0.85–0.99). In subgroup analysis, this benefit was more pronounced in patients with moderately reduced EF (40–49%) (RR 0.80; 95% CI: 0.67–0.96), while no significant difference was observed in patients with preserved EF (≥50%).

There were no significant differences between groups in all-cause mortality, cardiac death, recurrent MI, or heart failure.

Overall, BB therapy reduced CCE in patients with EF ≥40%, with benefit mainly seen in those with mildly reduced EF.

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