Outcomes in the BETAMI-DANBLOCK trial compared with a Norwegian nationwide myocardial infarction population.
Anna Meta Dyrvig Kristensen, Jarle Jortveit, Therese Holmager et al.
✦ AI-curated · Sources linked
In 30 seconds
This transportability analysis compared participants in the BETAMI and DANBLOCK randomized trials with revascularized Norwegian patients who had myocardial infarction, LVEF ≥40%, and no heart failure. The NORMI registry cohort included 20 804 patients; BETAMI and DANBLOCK included 2867 and 2707, respectively. At 3-year follow-up, all-cause mortality or MI risk was 12.0% in NORMI, versus 7.7% in BETAMI and 7.8% in DANBLOCK. Although registry patients were older and had more comorbidity, beta-blocker treatment effects were similar after weighting trial participants to match the registry.
Key findings
- At 3 years, all-cause mortality or MI risk was 12.0% in NORMI, 7.7% in BETAMI, and 7.8% in DANBLOCK.
- MI risk was 6.3% in NORMI, 5.6% in BETAMI, and 4.3% in DANBLOCK.
- NORMI patients were older (median 66 vs 63 years) and had more diabetes, prior coronary artery disease, and LVEF 40-49% than trial participants.
- Beta-blocker treatment effects were similar after weighting the trial population to reflect NORMI characteristics.
Why it matters
Trial participants differed from the broader Norwegian registry population in age, comorbidity, and observed event risk, highlighting the importance of assessing how well trial results apply beyond enrolled populations. The similar weighted treatment effects provide evidence that these differences did not materially alter the estimated beta-blocker effect in this analysis, while not eliminating uncertainty about generalisability to other settings.
What to keep in mind
The comparison was with a Norwegian registry cohort of revascularized patients, so representativeness beyond this population is not established. Transportability was assessed by weighting rather than by randomizing the registry cohort.