TREatment With Beta-blockers After myOcardial Infarction withOut Reduced Ejection fracTion

Study Overview
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Brief Summary
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REBOOT clinical trial will study whether long-term maintenance beta-blockers therapy results in a clinical benefit after heart attack without reduced left ventricular function. Half of the participants will be randomized to receive long-term beta-blocker therapy and the other half to no beta-blocker therapy after hospital discharge. All patients will be followed up for up to 3 years to determine the occurrence of adverse events (all cause mortality, re-infarction, and heart failure admission).

Detailed Description
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Pragmatic, controlled, prospective, randomized, open-label, blinded endpoint clinical trial testing the benefits of beta-blocker maintenance therapy in patients discharged after an acute myocardial infarction (MI). Patients being discharged after an acute MI, with or without ST-segment elevation, and with a left ventricular ejection fraction >40%, and without history of heart failure (HF) prior to study inclusion, will be recruited. At discharge, patients will be randomized (1:1) to receive beta-blocker therapy (agent and dose according to treating physician) or no beta-blocker therapy. Primary outcome is the 3 years incidence of MACE (all cause mortality, reinfarction, heart failure admission).

Official Title
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TREatment With Beta-blockers After myOcardial Infarction withOut Reduced Ejection fracTion

Conditions
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Myocardial Infarction

Intervention / Treatment
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* Drug: Beta blocker


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ≥18 years old Admitted for STEMI or NSTEMI and invasive management (i.e. coronary angiography during index hospitalization). LVEF>40% as evaluated by any imaging technique anytime during hospitalization. Signed informed consent Exclusion Criteria: Known allergy or intolerance to beta-blockers Absolute contraindication to beta-blocker therapy according to treating physician judge Prior history of HF, Killip class on admission or during hospitalization ≥ II Severe valvular heart disease (> 3+ for aortic or mitral insufficiency, aortic or mitral valve area ≤1.0 cm2). Any condition (appart from AMI) that requires beta-blocker prescription on discharge according to treating physician judge Any medical condition that, in the investigator´s judgment, would seriously limit life expectancy (less than one year), Patients participating in other clinical trials

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Beta-blocker therapy<br>This is a strategy (pragmatic) trial. In patients allocated to Beta-blocker therapy, beta blocker agent and dose are decided by treating physician. betablocker therapy chosen might be any of the following: atenolol bisoprolol carvedilol metoprolol nebivolol | Drug: Beta blocker<br>* long-term maintenance beta-blocker therapy<br>* Other names: atenolol, bisoprolol, carvedilol, metoprolol, nevibolol.;|
| No Intervention: Control (no beta-blocker therapy).<br>Do not receive beta -blocker therapy | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence rate of the composite of all-cause death, nonfatal reinfarction, or heart failure hospitalization (MACE) | absolute number of patients experiencing deaths will be added to number of patients experiencing a non fatal reinfarction and to number of patients experiencing heart failure hospitalization. If a patient experience more than one of these events, only first event will be added for the sum of events EXAMPLE events in arm 1: 150 deaths+150 reinfarctions+150 heart failure hospitalizations= TOTAL 450 MACE (450 events/4234 patients enroled: event rate 10.63%) | 24-36 months since the beginning (median follow up anticipated 2.75 months) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 1) Incidence rate of individual components of the primary outcome. 2) Incidence rate of cardiac mortality. | absolute number of events (% from total patients recruited) of the components of the MACE (eg number of all cause deaths (% from patients included) in active arm vs control). First event of each individual component counts for secondary outcome. EXAMPLE all cause death events in in arm 1: 200 deaths (200 events/4234 patients enroled: event rate 4.72%). nonfatal reinfarctions in in arm 1: 150 reinfarctions (150 events/4234 patients enroled: event rate 3.54%). note that in the example of the primary outcome, only 150 deaths are counted and for the secondary outcome 200. This is because in this hypothetical case, 50 deaths occurred in patients who previously experienced a nonfatal reinfarction | 24-36 months since the beginning (median follow up anticipated 2.75 months) |