Beta-blockers after invasively managed STEMI vs NSTEMI without reduced ejection fraction: a prespecified analysis from the REBOOT trial.

Abstract

Recent trials have questioned the clinical benefit of beta-blockers in post-myocardial infarction (MI) patients with preserved left ventricular ejection fraction (LVEF). However, differences in pathophysiology and risk profile between MI with and without ST-segment elevation (STEMI and NSTEMI) may influence the effect of beta-blockers. In this prespecified subgroup analysis of the REBOOT trial, which randomized invasively managed MI patients with LVEF > 40% to beta-blockers or control, we evaluated differences in long-term effects of the intervention between STEMI (n = 4296) and NSTEMI (n = 4142). The primary endpoint was a composite of all-cause death, reinfarction, or heart failure hospitalization over a median follow-up of 3.7 years.