Coronary disease & ACSSecondary analysis
Effect of beta blockers in acute and chronic coronary syndromes without reduced ejection fraction: a landmark analysis from the REBOOT trial
- pre-specified landmark analysis of the REBOOT trial
Authors' conclusion
In invasively treated MI patients with LVEF >40%, beta-blockers did not reduce adverse outcomes in either the ACS or CCS phases. These findings challenge their routine use in this population and support reconsidering current guidelines. Long-term beta-blocker users after MI may be candidates for deprescription.
Study context
- Population
- Invasively treated myocardial infarction (MI) patients with left ventricular ejection fraction (LVEF) >40%cohort 1 (acute coronary syndrome (ACS) period, first year) 8,438 · cohort 2 (chronic coronary syndrome (CCS) period, >1 year, event-free patients with follow-up) 7,783
- Participants
- 8,438 vs 7,783
- Comparison
- effect of beta-blocker therapy on outcomes in two post-MI phases: the ACS period (first year) and the CCS period (>1 year)
- ACS periodn = 8,438
- CCS periodn = 7,783
- Primary endpoint
- all-cause death, nonfatal reinfarction, or heart failure hospitalization
Primary result
As reported in the abstract
ACS period
28.9/1000 patient-years
238 of 8438
CCS period
19.3/1000 patient-years
385 of 7783
- Total primary outcome events
- 623
Secondary outcomes
Secondary prevention use
- Secondary prevention use was generally high, but patients with early events had lower prescription rates than those with late events or no events
Primary endpoint in patients with mildly reduced LVEF (41-49%) (subgroup) · first year
- A nonsignificant trend towards benefit of beta-blockers
Beta-blocker dose in the CCS phase
- higher beta-blocker doses were associated with worse outcomes
Original publication
Effect of beta blockers in acute and chronic coronary syndromes without reduced ejection fraction: a landmark analysis from the REBOOT trial. Eur Heart J Cardiovasc Pharmacother. Published 22 January 2026. doi:10.1093/ehjcvp/pvag002
Summarised from the published abstract; every number is checked against it