Heart Rate and Cardiovascular Outcomes in Post-Myocardial Infarction Patients Treated by β-Blockers: A Secondary Analysis of the ABYSS Trial.

We aim to evaluate the association between HR and β-blocker interruption on cardiovascular outcomes.

我们的目标是评估心率与β阻滞剂中断对心血管结果的关联。

Methods

A prespecified secondary analysis of the ABYSS trial (Assessment of Beta-Blocker Interruption 1 Year After an Uncomplicated Myocardial Infarction), including 3698 stable post-MI patients (left ventricular ejection fraction ≥40%) randomized to continue or interrupt β-blockers, was conducted.

我们对ABYSS试验（评估心肌梗死后一年β阻滞剂中断）进行了预先设定的次要分析，包括3698名稳定的心肌梗死患者（左心室射血分数≥40%），这些患者被随机分为继续或中断β阻滞剂治疗。

Patients were grouped by prerandomization HR tertiles: <60 bpm (T1), 60 to <68 (T2), and ≥68 (T3).

患者根据随机化前心率三分位数分组：＜60次/分钟（T1），60至＜68次/分钟（T2），和≥68次/分钟（T3）。

We examined associations between HR, treatment strategy, and the primary end point (death, MI, stroke, or cardiovascular rehospitalization), major secondary end points, and on-treatment HR.

我们检查了心率、治疗策略与主要终点（死亡、心肌梗死、中风或心血管再住院）、主要次要终点和治疗期间心率之间的关联。

Results

Median age in the study population was 63.5 years (55.9-71.1), and there were 621 women (17.1%).

研究人群的中位年龄为63.5岁（55.9-71.1），女性有621人（17.1%）。

Baseline HR was not associated with the primary end point (22.4% versus 21.8% versus 21.6%; P=0.867).

基线心率与主要终点无关（22.4%对比21.8%对比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).

较高的心率与死亡、心肌梗死或中风的风险增加相关（5.5%对比6.4%对比9.2%；P<0.001；T3对比T1调整后风险比，1.55；95% CI，1.14-2.12）以及死亡、心肌梗死、中风或心力衰竭（6.5%对比7.1%对比10.4%；P=0.007；T3对比T1调整后风险比，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.

全因死亡率在三个分位数中上升（2.9%对3.4%对5.9%；P=0.004；趋势P=0.008）。β-阻滞剂中断导致随访期间心率增加约10-13次/分钟，呈剂量依赖性。

The association between interruption and worse outcomes was consistent across HR tertiles (no significant interaction) and left ventricular ejection fraction categories (40% to 49% and >50%).

中断与更差结果之间的关联在心率分位数（无显著交互作用）和左心室射血分数类别（40%至49%和>50%）中是一致的。

Conclusions

In stabilized post-MI patients with preserved ejection fraction, higher HR remains associated with adverse cardiovascular events and mortality in the reperfusion era.

在心肌梗死后稳定且射血分数保持良好的患者中，较高的心率仍然与不良心血管事件和死亡率相关，这在再灌注时代尤其如此。

Interrupting β-blockers substantially increases HR and is consistently linked with worse outcomes irrespective of baseline HR, supporting continuation of β-blocker therapy.

中断β-阻滞剂显著增加心率，并且与更差的结果一致相关，无论基线心率如何，这支持继续使用β-阻滞剂治疗。