Hot Line 3: REBOOT-CNIC
31 Aug 2025
Hot Line ESC Congress 2025 Beta-blockers after MI in patients with LVEF >40%: REBOOT-CNIC
Explaining the rationale, Professor Borja Ibáñez (Centro Nacional de Investigaciones Cardiovasculares Carlos III [CNIC] and Fundación Jiménez Díaz University Hospital - Madrid, Spain) said: “Re-examining the role of beta-blockers is warranted, particularly among patients with uncomplicated myocardial infarction (MI) and LVEF >40% in whom the benefits of beta-blockers are not well established.”
This investigator-initiated trial, conducted in Spain and Italy, included patients with MI if they underwent invasive management and had predischarge LVEF >40%, with no history or signs of heart failure. In total, 8,505 patients were randomised to beta-blocker or no beta-blocker therapy. The mean age was 61 years, 19.3% were women and 12% were on beta-blockers before the index hospitalisation.
After a median follow-up of 3.7 years, the primary outcome of all-cause death, nonfatal reinfarction or heart failure admission was similar between the groups.
The primary outcome occurred in 22.5/1,000 patient-years (PY) in the beta-blocker group and 21.7/1,000 PY in the no beta-blocker group (hazard ratio [HR] 1.04; 95% CI 0.89 to 1.22; p=0.63). There appeared to be an absence of benefit with beta-blockers across the prespecified subgroups. However, fewer events were noted in patients with mildly reduced LVEF (40–49%) on beta-blockers vs. no beta-blockers.
All-cause mortality occurred in 11.2 and 10.5/1,000 PY on beta-blocker therapy and no beta-blocker therapy, respectively (HR 1.06; 95% CI 0.85 to 1.33). Nonfatal reinfarction occurred in 10.2 and 10.1/1,000 PY, respectively (HR 1.01; 95% CI 0.80 to 1.27), while heart failure admission occurred in 2.7 and 3.0/1,000 PY, respectively (HR 0.89; 95% CI 0.58 to 1.38).
Prof. Ibáñez concluded: “Beta-blocker therapy showed no evidence of benefit across the study population of patients with MI managed invasively who had LVEF >40%. However, as also presented today at ESC Congress, a meta-analysis of data from four trials, including REBOOT, suggest there may be a positive signal in patients with mildly reduced LVEF (40–49%).”
