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Publications

Journal Article Ahead of print

PubMed: 42267437 DOI: 10.1161/CIRCULATIONAHA.125.078635

Heart Rate and Cardiovascular Outcomes in Post-Myocardial Infarction Patients Treated by β-Blockers: A Secondary Analysis of the ABYSS Trial.

Circulation

Authors: Michel Zeitouni, Niki Procopi, Guillaume Cayla, Emile Ferrari, Grégoire Rangé, Etienne Puymirat, Nicolas Delarche, Paul Guedeney, Thomas Cuisset, Olivier Varenne, Romain Cador, Pascal Motreff, Luc-Philippe Christiaens, Anne Bellemain-Appaix, Maxime Fayard, Gilles Bayet, Jean-Michel Quédillac, Pascal Goube, Marc Goralski, Simon Elhadad, Frédéric Heliot, Christophe Caussin, Jean-Charles Aisenfarb, Jean Litalien, Geoffray Rambaud, David Attias, Raphaëlle Dumaine, Michel S Slama, Mohamad El Kasty, Laurent Payot, Karim Aacha, Abdourahmane Diallo, Eric Vicaut, Gilles Montalescot, Johanne Silvain

Affiliations

  • Institut de Cardiologie, AP-HP - Sorbonne Université, Hôpital Pitié-Salpêtrière, ACTION Group, Paris, France (M.Z. N.P. P. Guedeney, K.A).
  • Cardiology Department, Nimes University Hospital, Montpellier University, ACTION group, Nimes, France (G.C.).
  • CHU Nice, Université Côte d'Azur, Nice, France (E.F.).
  • Hôpital Européen Georges-Pompidou (AP-HP), Paris, France. Centre Hospitalier de Pau, Pau, France (E.P.).
  • AP-HM, Hôpital de la Timone, Marseille, France. Hôpital Cochin (AP-HP), Paris, France (N.D.).
  • Groupe Hospitalier Paris Saint-Joseph, Paris, France (R.C.).
  • CHU Clermont-Ferrand, Clermont-Ferrand, France (P.M.).
  • CHU de Poitiers, Poitiers, France (L.-P.C.).
  • Centre Hospitalier d'Antibes - Juan-les-Pins, Antibes, France (A.-B.A.).
  • Centre Hospitalier William-Morey, Chalon-sur-Saône, France (M.F.).
  • Clinique Rhône Durance, Avignon, France (G.B.).
  • Centre Hospitalier Bretagne Atlantique, Vannes, France (J.-M.Q.).
  • Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France (P. Goube).
  • CHU d'Orléans, Orléans, France (M.G.).
  • Grand Hôpital de l'Est Francilien (GHEF) - Site Marne-la-Vallée (Jossigny), France (S.E.).
  • CHR Metz-Thionville - Hôpital de Mercy (Metz/Ars-Laquenexy), France (F.H.).
  • Institut Mutualiste Montsouris (IMM), Paris, France (C.C.).
  • Centre Hospitalier de Dunkerque/Clinique de Flandre, Coudekerque-Branche, France (J.-C.A.).
  • Centre Hospitalier de Périgueux, Périgueux, France (J.L.).
  • Centre Hospitalier de Chartres (Hôpital Louis-Pasteur), Chartres, France (G.R).
  • Clinique Sainte-Clotilde, Saint-Denis (La Réunion), France (G.R.).
  • Centre Cardiologique du Nord (CCN), Saint-Denis, France (D.A.).
  • Centre de Réadaptation Cardiaque Les Grands Prés, Villeneuve-Saint-Denis, France (R.D.).
  • Hôpital Antoine-Béclère/Bichat (AP-HP), Paris, France (M.S.S.).
  • Grand Hôpital de l'Est Francilien (GHEF), Marne-la-Vallée, France (M.E.K.).
  • Hôpital Yves-Le-Foll, Saint-Brieuc, France (L.P.).
  • URC Lariboisière-Saint-Louis-Fernand Widal (AP-HP), ACTION Group, Paris, France (A.D.).

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.

MeSH

Mortality, Stroke, Myocardial Infarction, Heart Rate, Heart, Reperfusion, Therapeutics, Blood Circulation