Beta Blockers Offer No Benefit for Uncomplicated Heart Attack Patients, Landmark Trial Shows
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An international clinical trial coordinated by the National Cardiovascular research Centre (CNIC) in collaboration with the Mario Negri Institute of milan (Italy) has demonstrated that beta blockers, commonly used to treat various cardiac pathologies, provide no benefit to patients who have experienced an uncomplicated myocardial infarction – meaning the heart’s contractile function remains intact.
the findings, together published in The New England Journal of Medicine and The Lancet, and presented this Saturday at the Hot Line session of the European Society of Cardiology (ESC) Congress in Madrid, represent a paradigm shift in treatment, altering a medical practice maintained for over 40 years.A study with more than 8,500 patients
The REBOOT TEST (Treatment with Beta-Blockers after myocardial Infarction without Reduced Ejection Fraction) involved 8,505 patients across 109 hospitals in Spain and Italy. Participants where randomly assigned to receive or not receive beta blockers after hospital discharge, all while continuing with standard treatment. They were followed for an average of nearly four years. Results revealed no significant differences in mortality, re-infarction rates, or heart failure hospitalizations between the two groups.The reboot trial, with more than 8,500 patients, confirms that beta blockers do not reduce mortality or re-infarctions in uncomplicated infarcts
While generally safe, beta blockers can cause side effects such as fatigue, bradycardia (slow heart rate), or sexual dysfunction.
“Reboot is going to change treatment in these cases worldwide, since until now more than 80% of patients with this type of uncomplicated infarction are discharged with treatment with beta blockers,” states Dr. Borja Ibáñez, the study’s lead researcher, scientific director of the CNIC, cardiologist at the University Hospital Fundación Jiménez Díaz, and group head at the CIBER of Cardiovascular Diseases (CIBERCV). “Reboot results represent one of the most significant advances in the therapeutic strategy of acute myocardial infarction in recent decades,” he adds.
The benefits of these drugs are limited to patients with moderately reduced cardiac function,according to complementary meta-analysis
Following a heart attack,heart contractile function can be significantly deteriorated (left ventricular ejection fraction of less than 40%),moderately reduced (between 40% and 50%),or remain preserved (above 50%). Currently, most patients (approximately 70%) survive infarction with preserved cardiac function; around 20% have moderately reduced function, and 10% exhibit marked dysfunction.
the reebot study focused on the first two groups, as clear evidence regarding the benefits of beta blockers for these patient types was lacking. While the trial didn’t demonstrate significant benefits in the overall study population,a potential positive affect in patients with moderately reduced cardiac function was suggested by complementary meta-analysis.
Landmark “Reboot” Trial Set to Revolutionize Heart Attack Treatment Globally
A groundbreaking clinical trial, dubbed “Reboot,” led by the Spanish National Cardiovascular Research Center (CNIC), is poised to dramatically alter the standard of care for heart attack patients worldwide. the trial’s findings are expected to reshape international clinical guidelines and demonstrate the growing capacity of the Spanish scientific system to conduct impactful, large-scale cardiovascular research.
Trial Logistics and Spanish scientific Advancement
The CNIC’s Clinical Trial Coordination Unit (UCEC) spearheaded the logistical and data management aspects of the Reboot trial. This success underscores the ability of Spanish research institutions to successfully manage complex, international clinical studies focused on purely scientific objectives.The UCEC has become a pivotal entity in coordinating large-scale cardiology clinical trials.
“Reboot” – A Paradigm Shift in Treatment and Trial Design
The impact of Reboot extends beyond just treatment protocols. According to dr. Luis Rodríguez Padial, President of the Spanish Society of cardiology (SEC), “Reboot not only changes the treatment of infarction, but also the way of designing and executing clinical trials in Spain.” Dr. Ibáñez emphasized the meaning of the collaboration between CNIC, SEC, and CIBERCV, stating, “it speaks of the great potential that exists in Spain when a transformative project and solid scientific leadership is identified.”
The trial builds on previous successes led by the CNIC, including the Secure study (investigating a polypill approach) and the Dapatavi trial (examining SGLT2 inhibition in conjunction with TAVI – Transcatheter Aortic Valve Implantation). These prior studies have already significantly influenced the treatment of cardiovascular diseases globally. https://www.cnic.es/en/investigacion/proyectos-destacados/secure https://www.cnic.es/en/investigacion/proyectos-destacados/dapatavi
Dr. Valentín Fuster, General Director of the CNIC and President of the Mount Sinai Fuster Heart Hospital, and a Senior Reboot researcher, predicts that “This essay will change all international clinical guides and joins other great essays led by the CNIC…wich have already transformed the approach of cardiovascular diseases throughout the world.”
Funding and Institutional Support
The National Cardiovascular Research Center Carlos III (CNIC), affiliated with the Carlos III Health Institute (ISCIII) and operating under the Ministry of Science, Innovation and Universities, provided funding for the Reboot trial. https://www.cnic.es/en https://www.isciii.es/en
Key takeaways:
The “Reboot” trial, led by the CNIC, is expected to revolutionize heart attack treatment.
The trial highlights the growing capacity of Spain to lead large-scale, impactful clinical research.
Collaboration between CNIC,SEC,and CIBERCV was crucial to the project’s success.
Reboot builds upon previous CNIC successes like the Secure and Dapatavi trials.
* The trial’s findings will likely be incorporated into international clinical guidelines.
Looking ahead, the CNIC is well-positioned to continue leading innovative cardiovascular research and improving patient outcomes globally. The success of Reboot serves as a powerful example of the potential for collaborative,scientifically-driven research to transform healthcare.