Heart Rate and Cardiovascular Outcomes in Post–Myocardial Infarction Patients Treated by β-Blockers: A Secondary Analysis of the ABYSS Trial
Abstract
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: <60 bpm (T1), 60 to <68 (T2), and ≥68 (T3). We examined associations between HR, treatment strategy, and the primary endpoint (death, MI, stroke, or cardiovascular rehospitalization), major secondary endpoints, and on-treatment HR. RESULTS: Median age in the study population was 63.5 years (55.9–71.1), and there were 621 women (17.1%). Baseline HR was not associated with the primary endpoint (22.4% versus 21.8% versus 21.6%; P= 0.867). Higher HR was associated with increased risk of death, MI, or stroke (5.5% versus 6.4% versus 9.2%; P <0.001; T3 versus T1 adjusted hazard ratio, 1.55; 95% CI, 1.14–2.12) and death, MI, stroke, or heart failure (6.5% versus 7.1% versus 10.4%; P= 0.007; T3 versus T1 adjusted hazard ratio, 1.47; 95% CI, 1.11–1.97). All-cause mortality rose across tertiles (2.9% versus 3.4% versus 5.9%; P= 0.004; P trend=0.008). β-Blocker interruption produced a dose-dependent HR increase of ≈10–13 bpm during follow-up. The association between interruption and worse outcomes was consistent across HR tertiles (no significant interaction) and LVEF categories (40% to 49% and >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.
Article Details
Authors (35)
Michel Zeitouni
Institut de Cardiologie, AP-HP – Sorbonne Université, Hôpital Pitié-Salpêtrière, ACTION Group, Paris, France (M.Z., N.P., P. Guedeney, K.A).
Niki Procopi
Institut de Cardiologie, AP-HP – Sorbonne Université, Hôpital Pitié-Salpêtrière, ACTION Group, Paris, France (M.Z., N.P., P. Guedeney, K.A).
Guillaume Cayla
Cardiology Department, Nimes University Hospital, Montpellier University, ACTION Study Group, Nimes, France
Emile Ferrari
CHU Nice, Université Côte d’Azur, Nice, France (E.F.).
Gregoire Range
Les Hôpitaux de Chartres, Chartres, France
Etienne Puymirat
Université Paris-Cité, Paris
Nicolas Delarche
Paul Guedeney
Institut de Cardiologie, AP-HP – Sorbonne Université, Hôpital Pitié-Salpêtrière, ACTION Group, Paris, France (M.Z., N.P., P. Guedeney, K.A).
Thomas Cuisset
Centre Hospitalier Universitaire (CHU) La Timone, Marseille University, INSERM, Marseille, France
Olivier Varenne
Romain Cador
Groupe Hospitalier Paris Saint-Joseph, Paris, France (R.C.).
Pascal Motreff
CHU Clermont-Ferrand, Centre National de la Recherche Scientifique Unité Mixte de Recherche 6602, Clermont-Ferrand, France
Luc-Philippe Christiaens
CHU de Poitiers, Poitiers, France (L.-P.C.).
Anne Bellemain-Appaix
Centre Hospitalier d’Antibes – Juan-les-Pins, Antibes, France (A.-B.A.).
Maxime Fayard
Centre Hospitalier William-Morey, Chalon-sur-Saône, France (M.F.).
Gilles Bayet
Clinique Rhône Durance, Avignon, France (G.B.).
Jean-Michel Quédillac
Centre Hospitalier Bretagne Atlantique, Vannes, France (J.-M.Q.).
Pascal Goube
Marc Goralski
CHU d’Orléans, Orléans, France (M.G.).
Simon Elhadad
Grand Hôpital de l’Est Francilien (GHEF) – Site Marne-la-Vallée (Jossigny), France (S.E.).
Frédéric Heliot
CHR Metz-Thionville – Hôpital de Mercy (Metz/Ars-Laquenexy), France (F.H.).
Christophe Caussin
Institut Mutualiste Montsouris (IMM), Paris, France (C.C.).
Jean-Charles Aisenfarb
Centre Hospitalier de Dunkerque/Clinique de Flandre, Coudekerque-Branche, France (J.-C.A.).
Jean Litalien
Centre Hospitalier de Périgueux, Périgueux, France (J.L.).
Geoffray Rambaud
Centre Hospitalier de Chartres (Hôpital Louis-Pasteur), Chartres, France (G.R).
David Attias
Centre Cardiologique du Nord (CCN), Saint-Denis, France (D.A.).
Raphaëlle Dumaine
Centre de Réadaptation Cardiaque Les Grands Prés, Villeneuve-Saint-Denis, France (R.D.).
Michel S. Slama
Hôpital Antoine-Béclère/Bichat (AP-HP), Paris, France (M.S.S.).
Mohamad El Kasty
Grand Hôpital de l’Est Francilien (GHEF), Marne-la-Vallée, France (M.E.K.).
Laurent Payot
Hôpital Yves-Le-Foll, Saint-Brieuc, France (L.P.).
Karim Aacha
Institut de Cardiologie, AP-HP – Sorbonne Université, Hôpital Pitié-Salpêtrière, ACTION Group, Paris, France (M.Z., N.P., P. Guedeney, K.A).
Abdourahmane Diallo
Unité de Recherche Clinique de l’Est Parisien (URCEST), Paris
Eric Vicaut
Unité de Recherche Clinique de l’Est Parisien (URCEST), Paris
Gilles Montalescot
Sorbonne Université, Paris
Johanne Silvain