2026-06-14T02:28:11Zhttps://repisalud.isciii.es/rest/oai/request

oai:repisalud.isciii.es:20.500.12105/273572026-03-27T01:22:20Zcom_20.500.12105_19604com_20.500.12105_2051col_20.500.12105_19605

00925njm 22002777a 4500 dc Rossello, Xavier author Barrabés, José A author Piepoli, Massimo author Dominguez-Rodriguez, Alberto author Sánchez, Pedro L author Anguita, Manuel author Raposeiras-Roubín, Sergio author Grigis, Giulietta author Agüero, Jaume author Owen, Ruth author Pocock, Stuart author Pérez-García, Carlos Nicolás author Escalera, Noemí author Kallmeyer, Andrea author Sionis, Alessandro author Staszewsky, Lidia author Torres, Alfonso author Barquero, Rocio author Fernández-Vazquez, Felipe author Marín, Francisco author Vetrano, Alfredo author Pastor, Pablo author Fuster, Valentín author Latini, Roberto author Ibanez, Borja author 2026-02-27 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). 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. 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. Eur Heart J Cardiovasc Pharmacother. 2026 Feb 27;12(2):64-74. European Heart Journal. Cardiovascular Pharmacotherapy 41564893 https://hdl.handle.net/20.500.12105/27357 Acute coronary syndrome Chronic coronary syndrome Landmark analysis Randomized controlled trial beta blockers Effect of beta blockers in acute and chronic coronary syndromes without reduced ejection fraction: a landmark analysis from the REBOOT trial.