Coronary disease & ACSSecondary analysis
Heart Rate and Cardiovascular Outcomes in Post–Myocardial Infarction Patients Treated by β-Blockers: A Secondary Analysis of the ABYSS Trial
- Secondary analysis of the ABYSS randomised trial
- prespecified
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
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 stroke | 5.5% | 6.4% | 9.2% | 1.55 (1.14–2.12) | |
| Death, MI, stroke or HF | 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:10.1161/circulationaha.125.078635
Summarised from the published abstract; every number is checked against it