{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:25:42Z","timestamp":1793831142242,"version":"4.6.1"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008126","name":"Jeju National University Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008126","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Beta-blockers have been considered the cornerstone of treatment for patients with acute myocardial infarction (AMI). However, long-term benefits of vasodilating beta-blockers remain uncertain. This study aimed to investigate the long-term clinical benefits of vasodilating beta-blockers compared to conventional beta-blockers in AMI patients with mildly reduced ejection fraction (mrEF). Among 13,624 patients who enrolled in the nationwide AMI database of South Korea, the KAMIR-NIH Registry, 2,662 AMI patients with mrEF, who were prescribed beta-blockers at discharge were selected for this study. The primary outcome was a composite of cardiac death, recurrent MI, or hospitalization for heart failure (HF) during 3-year follow up period. In the entire cohort, the use of vasodilating beta-blockers at discharge was associated with lower incidence of primary outcome at 3-year (hazard ratio [HR] 0.80; 95% confidence interval [CI], 0.62\u20130.98; <jats:italic>P<\/jats:italic>\u2009=\u20090.039) compared to the use of conventional beta-blockers at discharge. In the propensity score\u2013matched (PSM) cohort, the use of vasodilating beta-blockers at discharge was also associated with a significantly lower incidence of primary outcome (HR, 0.66; 95% CI, 0.50\u20130.88; <jats:italic>P<\/jats:italic>\u2009=\u20090.004) compared to the use of conventional beta-blockers at discharge. Furthermore, in the PSM cohort, the use of vasodilating beta-blockers was associated with lower incidences of the cardiac death (HR, 0.60; 95% CI, 0.39\u20130.92; <jats:italic>P<\/jats:italic>\u2009=\u20090.020), hospitalization for HF (HR, 0.72; 95% CI, 0.46\u20130.98; <jats:italic>P<\/jats:italic>\u2009=\u20090.042), and all-cause death (HR, 0.67; 95% CI, 0.48\u20130.93; <jats:italic>P<\/jats:italic>\u2009=\u20090.017) compared to the use of conventional beta-blockers. However, no significant differences were observed between the groups in the incidences of recurrent MI (HR, 0.62; 95% CI, 0.34\u20131.14; <jats:italic>P<\/jats:italic>\u2009=\u20090.122), any revascularization (HR, 1.04; 95% CI, 0.76\u20131.42; <jats:italic>P<\/jats:italic>\u2009=\u20090.821), stroke (HR, 0.84; 95% CI, 0.44\u20131.60; <jats:italic>P<\/jats:italic>\u2009=\u20090.589), stent thrombosis (HR, 1.12; 95% CI, 0.40\u20133.11; <jats:italic>P<\/jats:italic>\u2009=\u20090.833). In AMI patients with mrEF, the use of vasodilating beta-blockers at discharge was associated with better long-term clinical outcomes compared to the use of conventional beta-blockers.<\/jats:p>","DOI":"10.1371\/journal.pone.0326516","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T17:39:15Z","timestamp":1750700355000},"page":"e0326516","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Long-term benefit of vasodilating beta-blockers in acute myocardial infarction patients with mildly reduced left ventricular ejection fraction"],"prefix":"10.1371","volume":"20","author":[{"given":"Ki Yung","family":"Boo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miyeon","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4915-9584","authenticated-orcid":true,"given":"Jae-Geun","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geum","family":"Ko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon Hyouk","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1170-8165","authenticated-orcid":true,"given":"Song-Yi","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4322-0703","authenticated-orcid":true,"given":"Seung-Jae","family":"Joo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6632-7239","authenticated-orcid":true,"given":"Jin-Yong","family":"Hwang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Ho","family":"Hur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwang Soo","family":"Cha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2424-810X","authenticated-orcid":true,"given":"Myung Ho","family":"Jeong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the KAMIR-NIH registry investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"issue":"4","key":"pone.0326516.ref001","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1056\/NEJM198407263110403","article-title":"Effect of propranolol on myocardial-infarct size in a randomized blinded multicenter trial","volume":"311","author":"R Roberts","year":"1984","journal-title":"N Engl J Med"},{"key":"pone.0326516.ref002","doi-asserted-by":"crossref","DOI":"10.1016\/j.cjca.2013.12.001","article-title":"Contemporary use of 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