The cardiovascular security of interrupting beta-blocker couldn’t be proven compared to continuation in sufferers with a historical past of myocardial infarction (MI) and there was no profit to the sufferers’ high quality of life, in response to late-breaking analysis offered August 30 at ESC Congress 2024.1
“Enhancements in MI administration and knowledge from observational research have led physicians to query whether or not persevering with beta-blockers after 1 yr post-MI is required since pointless remedy could lead to unwanted side effects.2-5 We carried out the ABYSS trial to supply conclusive randomised knowledge on the results of beta-blocker interruption vs. continuation on cardiovascular occasions and high quality of life, however we have been unable to indicate security preservation when it comes to medical occasions nor any profit on high quality of life with beta-blocker interruption,” mentioned Principal Investigator, Professor Johanne Silvain of the Sorbonne College, Paris, France.
The open-label, non-inferiority, randomised ABYSS trial, carried out by the ACTION Group, included sufferers with a previous MI taking long-term beta-blockers, with a left ventricular ejection fraction of a minimum of 40% and no cardiovascular occasions within the earlier 6 months. Contributors have been randomised (1:1) to interrupting or persevering with their β-blocker medicine.
The first endpoint was a composite of dying, non-fatal MI, non-fatal stroke or hospitalisation for cardiovascular causes on the longest follow-up (minimal, 1 yr), in response to an evaluation of non-inferiority (outlined as a between-group absolute distinction of <3 share factors for the higher boundary of the two-sided 95% confidence interval [CI]). The primary secondary endpoint was the change in high quality of life as measured by the European High quality of Life-5 Dimensions questionnaire.
In whole 3,698 sufferers have been randomised from 49 websites in France. The imply age was 64 years and 17% have been feminine. The median time between final MI and randomisation was 2.9 years (interquartile vary 1.2-6.4 years).
Over median follow-up of three years, interruption of long-term beta-blocker remedy was not proven to be non-inferior to beta-blocker continuation. A primary-outcome occasion occurred in 23.8% of sufferers within the interruption group and in 21.1% within the continuation group (danger distinction 2.8 share factors; 95% CI <0.1-5.5), with a hazard ratio of 1.16 (95% CI 1.01-1.33; p=0.44 for non-inferiority).
Loss of life occurred in 4.1% within the interruption group and 4.0% within the continuation group, whereas MI occurred in 2.5% and a pair of.4%, respectively. Of notice, hospitalisation for cardiovascular causes occurred in 18.9% within the interruption group and 16.6% within the continuation group. Beta-blocker interruption was additionally related to will increase in systolic and diastolic blood strain and coronary heart charge at 6 months (all p<0.001 vs. beta-blocker continuation) and in the course of the examine comply with up. Beta-blocker interruption didn’t enhance the sufferers’ high quality of life.
Summing up the proof from the ABYSS trial, Professor Silvain concluded: “Variations between the teams with respect to hospitalisation for cardiovascular causes and the unfavourable impact on blood strain ranges, along with the absence of quality-of-life enchancment don’t assist interruption of a continual beta-blocker remedy in post-MI sufferers. These outcomes have to be put into context with current findings from the open-label REDUCE-MI6 trial and ongoing trials to supply extra proof on the optimum use of beta-blockers after MI.”
1 ‘Beta blocker interruption in sufferers with prior myocardial infarction: outcomes of the ABYSS trial and impact on blood strain and coronary heart charge management’ will probably be mentioned throughout Scorching Line 1 on Friday 30 August in room London.
2 Holt A, Blanche P, Zareini B, et al. Impact of long-term beta-blocker remedy following myocardial infarction amongst secure, optimally handled sufferers with out coronary heart failure within the reperfusion period: a Danish, nationwide cohort examine. Eur Coronary heart J. 2021;42:907-914.
3 Park CS, Yang H-M, Ki Y-J, et al. Left ventricular ejection fraction 1 yr after acute myocardial infarction identifies the advantages of the long-term use of beta-blockers: evaluation of knowledge from the KAMIR-NIH Registry. Circ Cardiovasc Interv. 2021;14:e010159.
4 Puymirat E, Riant E, Aissaoui N, et al. β Blockers and mortality after myocardial infarction in sufferers with out coronary heart failure: multicentre potential cohort examine. BMJ. 2016;354:i4801.
5 Kim J, Kang D, Park H, et al. Lengthy-term β-blocker remedy and medical outcomes after acute myocardial infarction in sufferers with out coronary heart failure: nationwide cohort examine. Eur Coronary heart J. 2020;41:3521-3529.
6 Yndigegn T, Lindahl B, Mars Ok, et al. Beta-blockers after myocardial infarction and preserved ejection fraction. N Engl J Med. 2024;390:1372-1381.