Both published in The New England Journal of Medicine (NEJM), the Reduce-AMI and Abyss studies set out to evaluate the benefit of beta-blockers in long-term treatment after myocardial infarction (MI) in patients with preserved ejection fraction (LVEF). If the benefits of beta blockers have been shown in patients with extensive MI or in patients with LVEF less than 40%, these two trials indicate that they would not be as useful when LVEF is preserved to reduce the risk of death. or new IDM.
This was demonstrated by the Reduce-AMI trial (1) in patients whose LVEF was greater than 50% by comparing a group treated with beta-blockers (metoprolol or bisoprolol) to another not taking them. In the beta-blocker group, 7.9% of patients died or had a new MI compared to 8.3% in the group without beta-blockers. Concerning safety, the groups with and without beta blockers had 3.4 and 3.2% adverse events, respectively. In patients followed up at one year, the incidence and severity of symptoms were similar in the two groups. Following the Reduce-AMI results, a question still remained unanswered regarding patients with an LVEF between 40 and 49% for whom trials are underway.
A possible cessation of beta-blockers
This is how the Abyss study (2), signed by the Action group of the Pitié-Salpêtrière hospital (AP-HP), provided some additional elements of response. This work looked at the benefit of long-term treatment with beta-blockers after an MI in patients with an LVEF of at least 40% and concluded that there was no non-inferiority of discontinuation compared to continuation of beta-blockers. Abyss had the particularity of also evaluating non-selective beta-blockers, while Reduce-AMI was only interested in selective B1 receptor beta-blockers. Concerning the main composite endpoint (risk of death, non-fatal MI, non-fatal vascular accident or hospitalization for cardiovascular reasons), the authors found 23.8% of events in the interruption group compared to 21.1%. in the pursuit group. Given the absence of non-inferiority, the authors of Abyss indicated that the results should be compared to those of Reduce-AMI. For both Abyss and Reduce-AMI, continuing oral beta-blockers initiated during the acute phase of MI did not result in a lower risk of death or new MI.
For Dr Florian Zores, cardiologist, interviewed by The Dailyit is a safe bet that the European recommendations take these data into account for the indication of beta-blockers in patients with preserved LVEF. According to him, as for Professor Tomas Jernberg who signed the editorial, the Abyss results do not discourage trying to stop beta-blockers after an MI, except in complex situations. Both agree on the fact that the acceptable safety profile of this drug class should not be the only argument for prescribing them long-term in all patients after an MI. Other results are expected to continue to clarify the role of beta-blockers in the long term after an MI with preserved LVEF with the Reboot and Betani-Danblock trials as well as others solely dedicated to LVEFs between 40 and 49%.
(1) Yndigegn T et al. NEJM 2024.
DOI: 10.1056/NEJMoa2401479
(2) Silvain J et al. NEJM 2024.
DOI : 10.1056/NEJMoa2404204
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