The need for routine beta blockers post MI in contemporary practice has been questioned but a randomized trial of stopping vs continuing suggested they still have a role. John Mandrola, MD, disagrees.
I will argue why I think it is okay to stop beta-blockers after MI — despite this conclusion. The results of ABYSS are, in fact, similar to, which compared beta-blocker use or non-use immediately after MI, and found no difference in a composite endpoint of death or MI.
Over 3 years, a primary endpoint occurred in 23.8% of the interruption group vs 21.1% in the continuation group. ABYSS was a pragmatic open-label trial. The core problem with this design is that one of the components of the primary outcome requires clinical judgment — and is therefore susceptible to bias, particularly in an open-label trial.
ABYSS, therefore, is consistent with REDUCE-AMI. Taken together, along with the pessimistic priors, these are important findings because they allow us to stop a medicine and reduce the work of being a patient. Something as seemingly simple as choosing what to measure can alter the way clinicians interpret and use the data.
Cardiovascular Imaging Cardiac Imaging CV Imaging AMI Acute Myocardial Infarction Acute Myocardial Infarct Stroke Cerebrovascular Accident CVA - Cerebrovascular Accident Angiography Arteriography Beta-Adrenergic Agonists Beta Adrenergic Agonists Beta-Agonists Beta Agonists Left Ventricular Dysfunction Ejection Fraction EF - Ejection Fraction
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