Background There is a lack of evidence regarding the benefits of β-blocker treatment after invasively managed acute myocardial infarction (MI) without reduced left ventricular ejection fraction (LVEF). Methods and results TREatment with Beta-blockers after myOcardial infarction withOut reduced ejection fraction (REBOOT) trial is a pragmatic, controlled, prospective, randomized, open-label blinded endpoint (PROBE design) clinical trial testing the benefits of β-blocker maintenance therapy in patients discharged after MI with or without ST-segment elevation. Patients eligible for participation are those managed invasively during index hospitalization (coronary angiography), with LVEF >40%, and no history of heart failure (HF). At discharge, patients will be randomized 1:1 to β-blocker therapy (agent and dose according to treating physician) or no β-blocker therapy. The primary endpoint is a composite of all-cause death, nonfatal reinfarction, or HF hospitalization over a median follow-up period of 2.75 years (minimum 2 years, maximum 3 years). Key secondary endpoints include the incidence of the individual components of the primary composite endpoint, the incidence of cardiac death, and incidence of malignant ventricular arrhythmias or resuscitated cardiac arrest. The primary endpoint will be analyzed according to the intention-to-treat principle. Conclusion The REBOOT trial will provide robust evidence to guide the prescription of β-blockers to patients discharged after MI without reduced LVEF.

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Funding Acknowledgements Type of funding sources: None. Purpose and Methods The Covid-19 pandemic has led to an increase in demand for Critical Patient Care Units. For this reason, level III Coronary Units have become a very valuable resource in the care of seriously ill patients, especially those due to covid. Level II Coronary Units could have assumed a greater number of acute heart patients, especially coronary, during the pandemic in hospitals that have coronary units of different levels.  Our objective has been to compare the profile of patients who have been admitted to our level II Coronary Unit, retrospectively analyzing and comparing the demographic data and the reason for admission of the patients who were admitted between March and November 2019 (group I) with those who did so between the same months of 2020 (group II).  Results   Group I patients were 518 patients compared to 625 in group II. There was no difference between the age of the patients admitted (65.2 + 13 vs 65.1 + 13.8 years old). In the covid period, there were no significant differences between the classic risk factors, such as hypertension, diabetes or dyslipidemia. There was a higher percentage of smoking among the patients. During the pandemic, the patients admitted had significantly less history of previous heart disease (40.2% vs 78%). There has been a significant increase in admissions for acute ischemic heart disease in our unit (60% vs 13.8% the previous year), at the expense of Acute coronary syndrome with ST elevation (STEMI), with a downward trend in pathologies such as arrhythmias (13.5% in 2020 vs 20.6% in 2019) and acute heart failure (11.1% in 2020 vs 12.1% in 2019).  The average length of stay during the Covid-19 period was significantly shorter, 2.7 days, compared to 3.3 days in the 2019 period, at the expense of a higher turnover rate in the Unit (79.42 vs 74, 09). During the covid period, there were 36.67% more discharge.  Conclusions  During the Covid-19 pandemic, a significant increase in acute ischemic heart disease (STEMI) has been observed in our level II Coronary unit, which is responsible for the greater number of discharges and the decrease in our average length of stay. This has allowed level III Coronary Units the ability to assume the excess of patients in need of intensive care that has been significantly increased by the Covid-19 pandemic

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Introduction There is few data about long-term outcomes of conservative management (without catheter ablation) of patients with a first episode of arrhythmic storm (AS) in the current context. This study analyzes the short and long-term outcomes of implantable cardioverter defibrillator (ICD) patients with a first episode of AS receiving non-interventional management. Methods Consecutive patients admitted with a first episode of AS between January 2008 and June 2019 receiving medical management without catheter ablation were included. AS was defined as 3 or more appropriate ICD therapies occurring during a 24 h span. Medical management included: correction of triggers, sedation/mechanical ventilation, antiarrhythmic drugs, ICD reprogramming and neuraxial modulation. Baseline clinical characteristics and follow-up data were recorded. All patients were followed every 6 months at the ICD office. The primary end-point was all-cause mortality. Results 60 patients (81% male, 62.8±16.2 years, 43% ischaemic, LVEF 35.4±14%) with a first episode of AS treated conservatively were included. Thirty-day survival was 96.5% and 1-year survival was 82%. During a median (interquartilic range) follow-up of 31 (6–69) months, 31 (51.7%) patients died (51.6% due to cardiovascular aetiology) and 35 (58.3%) patients were readmitted (48.5% due to recurrent arrhythmic events and 45.7% due to heart failure). Age [HR 1.05 (95% confidence interval: 1.01–1.08)] and end-diastolic diameter [HR 1.05 (95% confidence interval: 1–2)] were the strongest independent predictors of all-cause mortality. Conclusion Despite the severity of this entity, medical management (without catheter ablation) of a first episode of AS is reasonable given its good 30-day and 1-year survival. However, a high rate of AS recurrence and readmissions are observed during long-term follow-up. Efforts are needed in order to identify those patients with a first episode of AS that could benefit from an early catheter ablation strategy. Funding Acknowledgement Type of funding source: None