ABYSS
Trial question
Is β-blocker interruption noninferior to β-blocker continuation in patients with a history of MI?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
17.0% female
83.0% male
N = 3698
3698 patients (637 female, 3061 male).
Inclusion criteria: patients with a history of MI.
Key exclusion criteria: chronic HF or a reduced LVEF; any cardiac event during the 6 months before enrollment; any other primary indication for β-blocker therapy, such as arrythmia, migraine, or uncontrolled hypertension.
Interventions
N=1846 β-blocker interruption (withdrawal of all types of β-blocker therapy).
N=1852 β-blocker continuation (continued use of β-blocker therapy with the same agent at the same dose).
Primary outcome
Death, nonfatal MI, nonfatal stroke, or hospitalization for cardiovascular reason
23.8%
21.1%
23.8 %
17.9 %
11.9 %
6.0 %
0.0 %
Beta-blocker
interruption
Beta-blocker
continuation
Difference exceeding
non-inferiority
margin ✗
Difference exceeding non-inferiority margin in death, nonfatal MI, nonfatal stroke, or hospitalization for cardiovascular reason (23.8% vs. 21.1%; HR 1.16, 95% CI 1.01 to 1.33).
Secondary outcomes
No significant difference in death, MI, or stroke (7.2% vs. 6.8%; HR 1.05, 95% CI 0.82 to 1.34).
No significant difference in death, MI, stroke, or hospitalization for HF (8.4% vs. 7.6%; HR 1.11, 95% CI 0.88 to 1.39).
Conclusion
In patients with a history of MI, β-blocker interruption was not noninferior to β-blocker continuation with respect to death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for cardiovascular reason.
Reference
Johanne Silvain, Guillaume Cayla, Emile Ferrari et al. Beta-Blocker Interruption or Continuation after Myocardial Infarction. N Engl J Med. 2024 Oct 10;391(14):1277-1286.
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