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βeta blocker interruption after uncomplicated myocardial infarction: rationale and design of the randomized ABYSS trial - 14/03/23

Doi : 10.1016/j.ahj.2023.01.014 
Johanne Silvain, MD,PhD a, , Guillaume Cayla, MD,PhD b, Emile Ferrari, MD,PhD c, Grégoire Range, MD d, Etienne Puymirat, MD,PhD e, f, Nicolas Delarche, MD g, Jean-Philippe Collet, MD,PhD a, Raphaelle Dumaine, MD h, Michel Slama, MD i, Laurent Payot, MD j, Mohamad E. Kasty, MD k, Karim Aacha, MD a, Eric Vicaut, MD,PhD l, Gilles Montalescot, MD,PhD a
on behalf of the

ABYSS investigators of the ACTION Study Group,

a Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France 
b Cardiology department, Nimes university Hospital, Montpellier University, ACTION group, Nimes, France 
c Cardiology Department, Pasteur University Hospital, France 
d Département de Cardiologie, Les Hôpitaux de Chartres, Chartres, France 
e Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France 
f Université de Paris Cité, Paris, France 
g Department of Cardiology, Hopital François Mitterrand, Pau, France 
h Les Grands Prés Cardiac Rehabilitation centre, Villeneuve St Denis, France 
i Cardiology Department Hôpital Bichat, AP-HP, Institut Mutualiste Montsouris, Paris, France 
j Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc, France 
k Département de Cardiologie, Grand Hôpital de l'Est Francilien site Marne-La-Vallée, Jossigny, France 
l Unité de Recherche Clinique, ACTION Study Group, Hôpital Fernand Widal (AP-HP), SAMM - Statistique, Analyse et Modélisation Multidisciplinaire EA 4543, Université Paris 1 Panthéon Sorbonne, Paris, France 

Reprint requests: Johanne Silvain, MD,PhD, ACTION Group, Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Bureau 7, 2ème étage, 47-83 bld de l'Hôpital, 75013 Paris, FranceACTION GroupSorbonne Université, INSERM UMRS1166Hôpital Pitié-Salpêtrière (AP-HP)Bureau 1, 2ème étage, 47-83 bld de l'HôpitalParis75013France

Riassunto

Background

The long-term use of β-blocker after myocardial infarction (MI) when global left ventricular ejection fraction (LVEF) is preserved has not been studied in the era of modern myocardial reperfusion and secondary prevention therapies. It is unknown whether β-blockers are useful in stable post-MI patients without reduced LVEF and without heart failure.

Methods

The Assessment of β-blocker interruption 1 Year after an uncomplicated myocardial infarction on Safety and Symptomatic cardiac events requiring hospitalization (ABYSS) Trial enrolled in 49 centers in France, 3,700 patients with a prior (>6 months) history of MI and a LVEF >40%, chronically treated with a β-blocker and without any major cardiovascular event (MACE) in the past 6 months. These patients were randomized to interruption or continuation of their β-blocker therapy. The primary objective is to demonstrate the noninferiority of interruption vs continuation of the β-blocker therapy on the primary composite endpoint of all-cause death, stroke, MI, hospitalization for any cardiovascular reason at the end of follow-up (accrual follow-up) with a one-year minimum follow-up for the last randomized patient. Secondary objectives will focus on patient reported outcomes with the evaluation of the quality of life before and after randomization with the EQ5D-5L questionnaire. Enrolment has been completed.

Conclusion

The ABYSS trial evaluates the cardiovascular safety of β-blocker interruption in stabilized post-MI patients without heart failure nor reduced LVEF. ABYSS trial is a reappraisal of β-blockers life-long therapy in stable post-MI patients without reduced LVEF.

Clinical trial registration

NCT03498066 (clinicaltrials.gov)

Il testo completo di questo articolo è disponibile in PDF.

List of abbreviations : ABYSS, ACS, APHP, βB, CEC, DSMB, ECG, ITT, MI, LVEF, MACE, MRI, NSTEMI, PP, PROBE, STEMI


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 ABYSS: The Assessment of β-blocker interruption one Year after an uncomplicated myocardial infarction on Safety and Symptomatic cardiac events requiring hospitalization NCT03498066


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