| Title: |
Effect of beta blockers in acute and chronic coronary syndromes without reduced ejection fraction: a landmark analysis from the REBOOT trial. |
| Authors: |
Rossello, Xavier; Barrabés, José A; Piepoli, Massimo; Dominguez-Rodriguez, Alberto; Sánchez, Pedro L; Anguita, Manuel; Raposeiras-Roubín, Sergio; Grigis, Giulietta; Agüero, Jaume; Owen, Ruth; Pocock, Stuart; Pérez-García, Carlos Nicolás; Escalera, Noemí; Kallmeyer, Andrea; Sionis, Alessandro; Staszewsky, Lidia; Torres, Alfonso; Barquero, Rocio; Fernández-Vazquez, Felipe; Marín, Francisco; Vetrano, Alfredo; Pastor, Pablo; Fuster, Valentín; Latini, Roberto; Ibanez, Borja |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2026 |
| Collection: |
London School of Hygiene & Tropical Medicine: LSHTM Research Online |
| Description: |
AIMS: Current guidelines recommend beta-blocker therapy after myocardial infarction (MI) regardless of left ventricular ejection fraction (LVEF). However, recent trials question their benefit in patients with preserved LVEF. No study has yet compared beta-blocker effects during the acute coronary syndrome (ACS) phase (≤1 year post-MI) vs. the chronic coronary syndrome (CCS) phase (>1 year). METHODS AND RESULTS: In this pre-specified landmark analysis of the REBOOT trial, we evaluated the effect of beta-blocker therapy on outcomes in two post-MI phases: the ACS period (first year; cohort 1, n = 8438) and the CCS period (>1 year, event-free patients with follow-up; cohort 2, n = 7783). The primary endpoint was all-cause death, nonfatal reinfarction, or heart failure hospitalization; secondary endpoints included individual and additional cardiovascular events. Among 623 primary outcome events, 238 occurred in the first year (28.9/1000 patient-years) and 385 thereafter (19.3/1000 patient-years). Secondary prevention use was generally high, but patients with early events had lower prescription rates than those with late events or no events. Beta-blockers were not associated with lower risk of the primary or component outcomes in either phase. A nonsignificant trend towards benefit of beta-blockers appeared during the first year in patients with mildly reduced LVEF (41-49%), whereas in the CCS phase, higher beta-blocker doses were associated with worse outcomes. 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. |
| Document Type: |
article in journal/newspaper |
| File Description: |
text |
| Language: |
English |
| ISSN: |
2055-6837 |
| Relation: |
https://researchonline.lshtm.ac.uk/id/eprint/4681499/1/Rosello-etal-2026-Effect-of-beta-blockers.pdf; Rossello, XavierORCID logo; Barrabés, José A; Piepoli, Massimo; Dominguez-Rodriguez, Alberto; Sánchez, Pedro L; Anguita, Manuel; Raposeiras-Roubín, Sergio; Grigis, Giulietta; Agüero, Jaume; Owen, Ruth; +15 more.Pocock, Stuart ; Pérez-García, Carlos Nicolás; Escalera, Noemí; Kallmeyer, Andrea; Sionis, AlessandroORCID logo; Staszewsky, Lidia; Torres, Alfonso; Barquero, Rocio; Fernández-Vazquez, Felipe; Marín, FranciscoORCID logo; Vetrano, Alfredo; Pastor, Pablo; Fuster, Valentín; Latini, RobertoORCID logo; and Ibanez, BorjaORCID logo (2026) Effect of beta blockers in acute and chronic coronary syndromes without reduced ejection fraction: a landmark analysis from the REBOOT trial. European heart journal. Cardiovascular pharmacotherapy, 12 (2). pp. 64-74. ISSN 2055-6837 DOI:10.1093/ehjcvp/pvag002 |
| DOI: |
10.1093/ehjcvp/pvag002 |
| Availability: |
https://researchonline.lshtm.ac.uk/id/eprint/4681499/; https://academic.oup.com/ehjcvp/article/12/2/64/8435830; https://doi.org/10.1093/ehjcvp/pvag002 |
| Rights: |
cc_by_4 |
| Accession Number: |
edsbas.DC36E831 |
| Database: |
BASE |