Coronary disease & ACSMeta-analysis
Discontinuation of β-blockers in stable patients with previous myocardial infarction, preserved left ventricular ejection fraction, and no heart failure: a pooled analysis of individual patient data
- Pooled analysis of individual patient data from the ABYSS and SMART-DECISION randomised trials
- non-inferiority
- one-stage mixed-effects Cox model, trial as random effect
- Median follow-up 3.0 years (2.3-3.8)
Median time from index MI to randomisation 3.6 years (IQR 1.6-7.5)
Authors' conclusion
In stable patients with previous myocardial infarction, left ventricular ejection fraction ≥40%, no heart failure, and no other indication for β-blocker therapy, discontinuation met the non-inferiority criteria for the primary and key secondary endpoints.
Study context
- Population
- Stable patients >6 months after MI with LVEF ≥40% and no HFpooled IPD, ABYSS and SMART-DECISION
- Participants
- 6,238 patients
- Comparison
- β-blocker discontinuation vs continuation
- Discontinuationn = 3,092
- Continuationn = 3,146reference
- Outcome
- All-cause death, MI, stroke, or hospitalisation for CV reasons
Pooled result
As reported in the abstract
Hazard ratio
1.09
95% CI 0.97–1.24
P = 0.016 for non-inferiority
Events by group
Discontinuation vs Continuation
HR 1.09 (95% CI 0.97–1.24); P for non-inferiority = 0.016
Further pooled results
| Outcome | Discontinuation | Continuation | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| Key secondary: all-cause death, MI, or hospitalisation for HF · non-inferiority margin 1.40 | 6.5% | 6.4% | 1.01 (0.83–1.23) | P for non-inferiority = 0.0006 | |
| 0.512Hazard ratio (log scale) |
Primary endpoint by background LVEF
- Findings consistent irrespective of background LVEF
Original publication
Discontinuation of β-blockers in stable patients with previous myocardial infarction, preserved left ventricular ejection fraction, and no heart failure: a pooled analysis of individual patient data. Lancet. Published 30 August 2026. doi:10.1016/s0140-6736(26)01426-1
Summarised from the published abstract; every number is checked against it