REBOOT
TREatment with Beta-blockers after myOcardial infarction withOut reduced ejection fracTion (REBOOT-CNIC)
Patient / Population Intervention / Exposure Comparison Outcome
In 8,505 patients after myocardial infarction with LVEF >40%, beta-blocker therapy did not reduce death, reinfarction, or HF hospitalisation compared with no beta-blocker.
N
8,505
Design
Multicentre open-label RCT with blinded endpoint adjudication (PROBE)
Endpoint
Death from any cause, reinfarction, or hospitalisation for heart failure
Relevance
2
ResultBeta-blocker vs no beta-blocker neutral (HR 1.04, 95% CI 0.89-1.22, P=0.63) over median ~3.7 years in post-MI patients with LVEF >40%.
Ibáñez B, et al. N Engl J Med. 2025;393(19):1889-1900. 10.1056/NEJMoa2504735
Discussion & critique
Open-label design and inclusion of mildly-reduced-EF (41-49%) patients make the preserved-EF message imprecise. With REDUCE-AMI is driving guidelines away from routine beta-blockade after MI when EF is preserved.