Assessment of Beta-Blocker Interruption 1 Year After an Uncomplicated Myocardial Infarction on Safety and Symptomatic Cardiac Events Requiring Hospitalization - ABYSS

Aug 30, 2024
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Kim A. Eagle, MD, MACC
Trial Sponsor:
French Ministry of Health and ACTION Study Group
Date Presented:
08/30/2024
Date Published:
08/30/2024
Original Posted Date:
08/30/2024
References

Contribution To Literature:

The ABYSS trial failed to show that beta-blocker interruption is noninferior to continuation.

Description:

The goal of the trial was to evaluate beta-blocker interruption compared with beta-blocker continuation after an uncomplicated myocardial infarction (MI).

Study Design

  • Randomized
  • Parallel
  • Open-label

Patients with prior MI were randomized to beta-blocker interruption (n = 1,846) versus beta-blocker continuation (n = 1,852).

  • Total number of enrollees: 3,698
  • Duration of follow-up: median 3 years
  • Mean patient age: 64 years
  • Percentage female: 17%
  • Percentage with diabetes: 20%

Inclusion criteria:                                      

  • MI ≥6 months before enrollment
  • Current use of a beta-blocker

Exclusion criteria:

  • Chronic heart failure
  • Left ventricular ejection fraction (LVEF) <40%
  • Any cardiac event within the last 6 months
  • Another indication for beta-blocker such as arrhythmia, migraine, or hypertension

Other salient features/characteristics:

  • Median time between MI and randomization: 2.9 years
  • Revascularization for index MI: 95%
  • Median LVEF: 60%

Principal Findings:

The primary outcome, death, MI, stroke, or hospitalization for a cardiovascular reason, was 23.8% in the interruption group vs. 21.1% in the continuation group (p for noninferiority = 0.44).

Secondary outcomes:

  • Death: 4.1% in the interruption group vs. 4.0% in the continuation group
  • MI: 2.5% in the interruption group vs. 2.4% in the continuation group
  • Stroke: 1.0% in the interruption group vs. 1.0% in the continuation group
  • Hospitalization for a cardiovascular reason: 18.9% in the interruption group vs. 16.6% in the continuation group
  • Beta-blocker interruption did not improve quality of life

Interpretation:

Among patients with uncomplicated MI, beta-blocker interruption was not found to be noninferior to beta-blocker continuation. Moreover, beta-blocker interruption did not improve quality of life. The median time between MI and randomization was 2.9 years and the median LVEF was 60%. In such individuals, the ongoing use of beta-blocker needs to be individualized.

References:

Silvain J, Cayla G, Ferrari E, et al., for the ABYSS Investigators of the ACTION Study Group. Beta-Blocker Interruption or Continuation After Myocardial Infarction. N Engl J Med 2024;Aug 30:[Epub ahead of print].

Editorial: Jernberg T. Routine Beta-Blockers in Secondary Prevention — Approaching Retirement? N Engl J Med 2024;Aug 30:[Epub ahead of print].

Presented by Dr. Johanne Silvain at the European Society of Cardiology Congress, London, UK, August 30, 2024.

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies

Keywords: Adrenergic beta-Antagonists, Myocardial Infarction, Ventricular Function, Left, ESC24, ESC Congress


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