Higher baseline heart rate (≥68 vs <60 bpm) increased the risk of death, MI, or stroke (9.2% vs 5.5%; HR 1.55, 95% CI 1.14-2.12), and β-blocker interruption consistently worsened outcomes.
RCT (n=3,698)
randomized
Does β-blocker interruption worsen cardiovascular outcomes compared to continuation in stable post-MI patients with LVEF ≥40%, and is this effect modified by baseline heart rate?
In stable post-MI patients with LVEF ≥40%, higher baseline heart rate is associated with increased mortality and cardiovascular events, and interrupting β-blockers increases heart rate and worsens outcomes regardless of baseline heart rate.
Absolute Event Rate: 21.6% vs 22.4%
p-value: p=0.867
BACKGROUND: Heart rate (HR) is a key prognostic factor after myocardial infarction (MI), but its relevance in the modern reperfusion era is uncertain. We aim to evaluate the association between HR and β-blocker interruption on cardiovascular outcomes. METHODS: A prespecified secondary analysis of the ABYSS trial (Assessment of Beta-Blocker Interruption 1 Year After an Uncomplicted Myocardial Infarction), including 3698 stable post-MI patients (left ventricular ejection fraction ≥40%) randomized to continue or interrupt β-blockers, was conducted. Patients were grouped by prerandomization HR tertiles: 50%). CONCLUSIONS: In stabilized post-MI patients with preserved ejection fraction, higher HR remains associated with adverse cardiovascular events and mortality in the reperfusion era. Interrupting β-blockers substantially increases HR and is consistently linked with worse outcomes irrespective of baseline HR, supporting continuation of β-blocker therapy.
“Knowing our results now, I would probably not stop a drug that is well tolerated [and whose] cost is quite low. In people on chronic beta-blocker therapy, you've already selected [out] people who don't tolerate the drug, so there's not much benefit of stopping [in those on long-term treatment]. What we show here is that there's a safety signal to stopping.”
Zeitouni et al. (Wed,) conducted a rct in stable post-myocardial infarction (n=3,698). Higher baseline heart rate (≥68 bpm) vs. Lower baseline heart rate (<60 bpm) was evaluated on death, MI, stroke, or cardiovascular rehospitalization (p=0.867). Higher baseline heart rate (≥68 vs <60 bpm) increased the risk of death, MI, or stroke (9.2% vs 5.5%; HR 1.55, 95% CI 1.14-2.12), and β-blocker interruption consistently worsened outcomes.