REDUCE-AMI
Trial question
What is the role of β-blockers in patients with MI who underwent early coronary angiography and had a preserved ejection fraction?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
23.0% female
77.0% male
N = 5020
5020 patients (1131 female, 3889 male).
Inclusion criteria: adult patients with acute MI who had undergone coronary angiography and had a ejection fraction ≥ 50%.
Key exclusion criteria: an indication for or contraindication to β-blocker therapy.
Interventions
N=2508 β-blockers (either a target dose of at least 100 mg daily metoprolol or 5 mg daily bisoprolol).
N=2512 no β-blockers (discouraged from using β-blockers).
Primary outcome
Death from any cause or a new MI
7.9%
8.3%
8.3 %
6.2 %
4.2 %
2.1 %
0.0 %
Beta-blockers
No
beta-blockers
No significant
difference ↔
No significant difference in death from any cause or a new MI (7.9% vs. 8.3%; HR 0.96, 96% CI 0.79 to 1.16).
Secondary outcomes
No significant difference in death from any cause (3.9% vs. 4.1%; HR 0.94, 95% CI 0.71 to 1.24).
No significant difference in CV death (1.5% vs. 1.3%; HR 1.15, 95% CI 0.72 to 1.84).
No significant difference in MI (4.5% vs. 4.7%; HR 0.96, 96% CI 0.74 to 1.24).
Safety outcomes
No significant differences in hospitalization for bradycardia, second- or third-degree AV block, hypotension, syncope, or implantation of a pacemaker; hospitalization for asthma or COPD; hospitalization for stroke.
Conclusion
In adult patients with acute MI who had undergone coronary angiography and had a ejection fraction ≥ 50%, β-blockers were not superior to no β-blockers with respect to death from any cause or a new myocardial infarction.
Reference
Troels Yndigegn, Bertil Lindahl, Katarina Mars et al. Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction. N Engl J Med. 2024 Apr 18;390(15):1372-1381.
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