Heart Rate and Cardiovascular Outcomes in Post–Myocardial Infarction Patients Treated by β-Blockers: A Secondary Analysis of the ABYSS Trial
Authors' conclusion
In stabilized post-MI patients with preserved ejection fraction, higher HR remains associated with adverse cardiovascular events and mortality in the reperfusion era.
Study context
- Population
- Stable post-MI patients (LVEF ≥40%) randomised to continue or interrupt β-blockers
- Participants
- 3,698 patients
- Comparison
- Prerandomization HR tertiles; β-blocker continuation vs interruption
- Primary endpoint
- Death, MI, stroke or CV rehospitalization
Methodological detailsprespecified
- Prespecified
Primary result
As reported in the abstract
Primary end point (death, MI, stroke or CV rehospitalization) by baseline HR tertile
Baseline HR not associated with primary end point (T1 <60 bpm vs T2 60 to <68 vs T3 ≥68)
22.4% versus 21.8% versus 21.6%; P=0.867
Secondary outcomes
| Outcome | T1 | T2 | T3 | Adjusted HR (95% CI) | |
|---|---|---|---|---|---|
| Death, MI or strokeT3 vs T1 | 5.5% | 6.4% | 9.2% | 1.55 (1.14–2.12) | |
| Death, MI, stroke or HFT3 vs T1 | 6.5% | 7.1% | 10.4% | 1.47 (1.11–1.97) | |
| 0.512Adjusted hazard ratio (log scale) |
All-cause mortality
- Death, myocardial infarction (MI) or stroke: across tertiles P<0.001
- Death, MI, stroke or HF: across tertiles P=0.007
- All-cause mortality: P=0.004
- All-cause mortality: P trend=0.008
On-treatment HR after β-blocker interruption · during follow-up
- Dose-dependent HR increase with interruption
- ≈10-13 bpm
Interruption vs continuation, by HR tertile and LVEF category
- Association of interruption with worse outcomes consistent across HR tertiles (no significant interaction) and LVEF categories (40% to 49% and >50%)
Original publication
Heart Rate and Cardiovascular Outcomes in Post–Myocardial Infarction Patients Treated by β-Blockers: A Secondary Analysis of the ABYSS Trial. Circulation. Published 10 June 2026. doi:10.
Summarised from the published abstract; every number is checked against it