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Heart Rate and Cardiovascular Outcomes in Post-Myocardial Infarction Patients Treated by β-Blockers: A Secondary
Michel Zeitouni1, Niki Procopi1, Guillaume Cayla2
1Institut de Cardiologie, AP-HP - Sorbonne Université, Hôpital Pitié-Salpêtrière, ACTION Group, Paris, France (M.Z., N.P., P. Guedeney, K.A).
Insights
Higher heart rate (HR) after myocardial infarction (MI) is linked to worse cardiovascular outcomes. Interrupting beta-blocker therapy significantly increases HR and is associated with poorer results, underscoring the importance of continuous treatment.
Area of Science:
- Cardiology
- Clinical Research
- Internal Medicine
Background:
- Heart rate (HR) is a crucial prognostic indicator post-myocardial infarction (MI).
- The significance of HR in the current reperfusion era remains under investigation.
- This study evaluates the impact of HR and beta-blocker interruption on cardiovascular outcomes.
Purpose of the Study:
- To assess the association between heart rate and cardiovascular outcomes in stable post-MI patients.
- To determine the effect of beta-blocker interruption on heart rate and clinical events.
- To analyze HR's prognostic value in the modern reperfusion setting.
Main Methods:
- Secondary analysis of the ABYSS trial involving 3698 stable post-MI patients.
- Patients were categorized into three baseline HR tertiles (<60, 60-<68, ≥68 bpm).
- Examined associations between HR, beta-blocker strategy, and composite endpoints (death, MI, stroke, rehospitalization).
Main Results:
- Higher baseline HR was not significantly associated with the primary composite endpoint.
- Elevated HR correlated with increased risks of death, MI, or stroke, and death, MI, stroke, or heart failure.
- All-cause mortality increased across higher HR tertiles (P=0.004).
- Beta-blocker interruption led to a dose-dependent HR increase of ~10-13 bpm.
- Worse outcomes linked to beta-blocker interruption were consistent across HR tertiles and ejection fraction categories.
Conclusions:
- In stabilized post-MI patients with preserved ejection fraction, higher HR is associated with adverse cardiovascular events and mortality.
- Interrupting beta-blockers significantly raises HR and is consistently linked to worse outcomes.
- Continuation of beta-blocker therapy is supported to maintain optimal HR control and improve patient outcomes.
Background:
Heart rate (HR) is a key prognostic factor after myocardial infarction (MI), but its relevance in the modern reperfusion era is uncertain. We aim to evaluate the association between HR and β-blocker interruption on cardiovascular outcomes.
Methods:
A prespecified secondary analysis of the ABYSS trial (Assessment of Beta-Blocker Interruption 1 Year After an Uncomplicted Myocardial Infarction), including 3698 stable post-MI patients (left ventricular ejection fraction ≥40%) randomized to continue or interrupt β-blockers, was conducted. Patients were grouped by prerandomization HR tertiles: <60 bpm (T1), 60 to <68 (T2), and ≥68 (T3). We examined associations between HR, treatment strategy, and the primary endpoint (death, MI, stroke, or cardiovascular rehospitalization), major secondary endpoints, and on-treatment HR.
Results:
Median age in the study population was 63.5 years (55.9-71.1), and there were 621 women (17.1%). Baseline HR was not associated with the primary endpoint (22.4% versus 21.8% versus 21.6%; P=0.867). Higher HR was associated with increased risk of death, MI, or stroke (5.5% versus 6.4% versus 9.2%; P<0.001; T3 versus T1 adjusted hazard ratio, 1.55; 95% CI, 1.14-2.12) and death, MI, stroke, or heart failure (6.5% versus 7.1% versus 10.4%; P=0.007; T3 versus T1 adjusted hazard ratio, 1.47; 95% CI, 1.11-1.97). All-cause mortality rose across tertiles (2.9% versus 3.4% versus 5.9%; P=0.004; P trend=0.008). β-Blocker interruption produced a dose-dependent HR increase of ≈10-13 bpm during follow-up. The association between interruption and worse outcomes was consistent across HR tertiles (no significant interaction) and LVEF categories (40% to 49% and >50%).
Conclusions:
In stabilized post-MI patients with preserved ejection fraction, higher HR remains associated with adverse cardiovascular events and mortality in the reperfusion era. Interrupting β-blockers substantially increases HR and is consistently linked with worse outcomes irrespective of baseline HR, supporting continuation of β-blocker therapy.
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