https://doi.org/10.55788/b84f4e41
In post-MI patients with reduced EF, beta-blocker treatment has demonstrated a clear mortality reduction, but its benefit for those with a preserved EF who are revascularised is uncertain in the era of reperfusion treatment [1]. To generate more data to clarify this matter, Dr Troels Yndigegn (Lund University, Sweden) and colleagues designed the phase 4 REDUCE-AMI trial (NCT03278509).
This registry-based prospective, randomised, open-label trial included over 5,000 adults who received early coronary angiography and had an EF â„50% after an MI between 2017 and 2023. The beta-blocker group was treated with either daily 100 mg metoprolol succinate or 5 mg bisoprolol, and participants were encouraged to continue treatment post-discharge. The other study arm received no beta-blockers unless there was an indication beyond secondary prevention. The study cohort had a median age of 65 years and included about 22% women. âThere was a high degree of adherence to guideline-directed therapy,â Dr Yndigegn noted. Participants were followed over a median of 3.5 years.
The primary composite outcome of all-cause death or new MI showed no significant difference between groups: 199 events were observed for participants on beta-blockers and 208 events for those not on beta-blockers (HR 0.96; 95% CI 0.79â1.16; P=0.64). Also, no reductions were found for any of the secondary outcomes, and the analysis of all prespecified subgroups suggested similar treatment effects regarding the primary outcome.
The safety endpoints showed overall similar risks between the study arms. This included bradycardia, hypotension, asthma, and hospitalisation for stroke.
âAll therapies need an expiration date or re-evaluation when there is a change in underlying risk due to advancement in medical therapy; in patients with MI and preserved EF who underwent prompt revascularisation and were on guideline-directed medical therapy, there is no role for beta-blockers to improve clinical outcomes or symptoms,â said discussant Prof. Sripal Bangalore (New York University School of Medicine, NY, USA) [2]. He also emphasised that in patients with heart failure with reduced EF, beta-blockers should continue to be the cornerstone of therapy.
- Yndigegn T. Long-term beta-blocker treatment after acute myocardial infarction and preserved left ventricular ejection fraction - the REDUCE-AMI trial. LB3, Session 406, ACC 2024 Scientific Session, 6â8 April, Atlanta, USA.
- Bangalore S. The REDUCE-AMI trial. Session 414, ACC 2024 Scientific Session, 6â8 April, Atlanta, USA.
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Table of Contents: ACC 2024
Featured articles
Matters of the heart: late-breaking news from the American College of Cardiology
Heart Failure and Cardiomyopathy
STEP-HFpEF DM: Semaglutide beneficial in patients with HFpEF and diabetes
IMPROVE-HCM: Promising results for ninerafaxstat in non-obstructive HCM
Acute Coronary Syndrome and Acute Myocardial Infarction
ACS: Necessary DAPT after PCI may be shorter than currently advised
AEGIS-II: ApoA-1 did not reduce MACE in patients with myocardial infarction but may provide benefit in patients with high LDL levels
REDUCE-AMI: Re-evaluating the role of routine beta-blockade in patients with acute myocardial infarction
Interventional Cardiology in 2024
Self-expanding versus balloon-expendable TAVR in patients with small aortic annuli
Safety of TAVI non-inferior to SAVR for patients with lower surgical risk
Interatrial shunt for HF: neutral primary endpoint but potential benefit in HFrEF
Peripheral artery disease: procedure-guidance by IVUS superior to angiography
IVUS-guided PCI beats angiography in patients with acute coronary syndrome
Addressing frailty in patients undergoing TAVR
Novel Developments in Risk Factor Management
Preventive PCI of vulnerable intracoronary plaque leads to favourable outcomes
KARDIA-2: Add-on zilebesiran effectively lowers blood pressure
BRIDGE-TIMI 73a: Olezarsen halves triglyceride levels
Plozasiran: A novel approach to severe hypertriglyceridaemia
High-risk and very high-risk patients meet LDL-cholesterol targets with lerodalcibep
No cardioprotective effect of ACE inhibitors in patients with cancer
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Anxiety and depression: Lifestyle influential in MACE prevention
Meet the Trialists
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