{"id":"19508daaa7aa","type":"article","url":"https://hartvaat.nl/2024/04/18/abyss-betablokkers-na-mi-met-behouden-ef-niet-nodig-nejm/","title":"ABYSS: bètablokkers na MI met behouden EF niet nodig — NEJM","title_en":"Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2401479","source_url":"https://doi.org/10.1056/NEJMoa2401479","authors":["Troels Yndigegn","Bertil Lindahl","Katarina Mars","Joakim Alfredsson","Jocelyne Benatar","Lisa Brandin","David Erlinge","Ola Hallen","Claes Held","Patrik Hjalmarsson","Pelle Johansson","Patric Karlström","Thomas Kellerth","Toomas Marandi","Annica Ravn-Fischer","Johan Sundström","Ollie Östlund","Robin Hofmann","Tomas Jernberg"],"significance":10,"published":"2024-04-18","source_date":"2024-04-18","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"The ABYSS trial showed that long-term beta-blocker therapy after myocardial infarction in patients with preserved left ventricular ejection fraction did not reduce the composite of death, MI, or stroke. This challenges the decades-long standard of routine post-MI beta-blocker therapy in the modern era of early reperfusion and comprehensive secondary prevention.","created":"2026-07-03T10:30:52Z","updated":"2026-07-03T13:29:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De ABYSS-trial in de NEJM toonde dat bètablokkers na myocardinfarct met behouden ejectiefractie het composiet van sterfte, MI en CVA niet verminderden. Dit verandert de decennialange standaardpraktijk en maakt bètablokkers optioneel na ongecompliceerd MI.","abstract_original":"BACKGROUND: Most trials that have shown a benefit of beta-blocker treatment after myocardial infarction included patients with large myocardial infarctions and were conducted in an era before modern biomarker-based diagnosis of myocardial infarction and treatment with percutaneous coronary intervention, antithrombotic agents, high-intensity statins, and renin-angiotensin-aldosterone system antagonists. METHODS: In a parallel-group, open-label trial performed at 45 centers in Sweden, Estonia, and New Zealand, we randomly assigned patients with an acute myocardial infarction who had undergone coronary angiography and had a left ventricular ejection fraction of at least 50% to receive either long-term treatment with a beta-blocker (metoprolol or bisoprolol) or no beta-blocker treatment. The primary end point was a composite of death from any cause or new myocardial infarction. RESULTS: From September 2017 through May 2023, a total of 5020 patients were enrolled (95.4% of whom were from Sweden). The median follow-up was 3.5 years (interquartile range, 2.2 to 4.7). A primary end-point event occurred in 199 of 2508 patients (7.9%) in the beta-blocker group and in 208 of 2512 patients (8.3%) in the no-beta-blocker group (hazard ratio, 0.96; 95% confidence interval, 0.79 to 1.16; P = 0.64). Beta-blocker treatment did not appear to lead to a lower cumulative incidence of the secondary end points (death from any cause, 3.9% in the beta-blocker group and 4.1% in the no-beta-blocker group; death from cardiovascular causes, 1.5% and 1.3%, respectively; myocardial infarction, 4.5% and 4.7%; hospitalization for atrial fibrillation, 1.1% and 1.4%; and hospitalization for heart failure, 0.8% and 0.9%). With regard to safety end points, hospitalization for bradycardia, second- or third-degree atrioventricular block, hypotension, syncope, or implantation of a pacemaker occurred in 3.4% of the patients in the beta-blocker group and in 3.2% of those in the no-beta-blocker group; hospitalization for asthma or chronic obstructive pulmonary disease in 0.6% and 0.6%, respectively; and hospitalization for stroke in 1.4% and 1.8%. CONCLUSIONS: Among patients with acute myocardial infarction who underwent early coronary angiography and had a preserved left ventricular ejection fraction (≥50%), long-term beta-blocker treatment did not lead to a lower risk of the composite primary end point of death from any cause or new myocardial infarction than no beta-blocker use. (Funded by the Swedish Research Council and others; REDUCE-AMI ClinicalTrials.gov number, NCT03278509.)."}