ABYSS Trial: No Significant Difference in Outcomes Between Continuing or Stopping Beta-Blockers Post-MI
核心洞察
The ABYSS trial investigated the impact of interrupting versus continuing beta-blocker treatment in post-myocardial infarction (搜索) patients with preserved ejection fraction.
Results showed no significant difference in the composite primary outcome of death, nonfatal myocardial infarction (搜索), stroke (搜索), or cardiovascular hospitalization.
Hospitalization for cardiovascular causes was slightly higher in the interruption group, suggesting potential risks associated with discontinuing beta-blockers (搜索).
The ABYSS trial has cast further doubt on the necessity of continuing beta-blocker treatment in patients with a history of myocardial infarction (搜索) (MI) and preserved ejection fraction. Presented at the European Society of Cardiology (ESC) Congress 2024, the trial, while not demonstrating safety preservation with beta-blocker interruption, also failed to show any significant benefit in quality of life.
Study Design and Patient Population
The open-label, non-inferiority, randomized trial enrolled 3,698 patients from 49 sites in France. Participants had a history of prior MI, were taking long-term beta-blockers (搜索), had a left ventricular ejection fraction of at least 40%, and had no cardiovascular events in the preceding 6 months. The mean age of the cohort was 63.5 years, with 17.2% being women. The median time between MI and randomization was 2.9 years, and the median follow-up was 3.0 years.
Key Findings
The primary outcome, a composite of death, nonfatal myocardial infarction (搜索), nonfatal stroke (搜索), or hospitalization for cardiovascular reasons, occurred in 23.8% of the interruption group and 21.1% of the continuation group (risk difference, 2.8 percentage points; 95% CI, <0.1 to 5.5; HR, 1.16; 95% CI, 1.01 to 1.33; P = .44 for noninferiority). The mean change in quality of life, as measured by the European Quality of Life–5 Dimensions (EQ-5D) questionnaire, was similar in both groups.
Individual components of the primary outcome revealed similar rates of death (4.1% vs 4.0%), myocardial infarction (搜索) (2.5% vs 2.4%), and stroke (搜索) (1.0% vs 1.0%) in the interruption and continuation groups, respectively. However, hospitalization for cardiovascular causes was more frequent in the interruption group (18.9%) compared to the continuation group (16.6%).
Expert Commentary
Principal investigator Johanne Silvain, MD, PhD, head of Department of Cardiology at the Pitié-Salpêtrière University Hospital, stated that the increased hospitalization for cardiovascular reasons and the lack of quality-of-life improvement do not support the interruption of chronic beta-blocker treatment in post-MI patients. She emphasized the need to consider these results in the context of other trials, such as the REDUCE-MI trial, to gain a more comprehensive understanding of optimal beta-blocker use after MI.
Tomas Jernberg, MD, PhD, professor of Cardiology at the Karolinska Institute (搜索), cautioned against overinterpreting the ABYSS and REDUCE-AMI trials, advocating for waiting for results from additional ongoing trials before definitively updating guidelines. He anticipates that these trials will provide more conclusive evidence regarding beta-blocker treatment in this patient population.