In patients with myocardial infarction without reduced ejection fraction, beta-blockers did not significantly reduce the risk of all-cause mortality compared to no beta-blockers (RR 0.98).
Meta-Analysis (n=23,524)
Do beta-blockers reduce all-cause mortality, recurrent MI, and heart failure in adults with MI and LVEF ≥ 40%?
Among patients with myocardial infarction and preserved LVEF, routine long-term use of beta-blockers does not reduce mortality, ischemic, or heart failure events.
Effect estimate: RR 0.98 (95% CI 0.87-1.11)
Absolute Event Rate: 4% vs 4.1%
BACKGROUND: The long-term benefit of beta-blockers (β-blockers) after myocardial infarction (MI) in patients with preserved left-ventricular ejection fraction (LVEF ≥ 40%) remains uncertain in the modern reperfusion era. Earlier trials showed mortality benefits, but contemporary therapies may have altered their effect. METHODS: We conducted a meta-analysis of randomized controlled trials (RCTs) comparing β-blockers versus no β-blockers in adults with MI and LVEF ≥ 40%. PubMed, Scopus, Web of Science, and Cochrane CENTRAL were searched through October 2025. Primary outcomes were all-cause mortality, recurrent MI, and heart failure (HF). Individual patient data (IPD) were reconstructed from Kaplan-Meier curves for time-to-event analysis, and pooled risk ratios (RRs) and hazard ratios (HRs) were estimated using random-effects models. Trial sequential analysis (TSA), meta-regression, and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) certainty assessments were performed. RESULTS: Five RCTs (n = 23,524 patients) met inclusion criteria. β-Blockers did not significantly reduce recurrent acute myocardial infarction (AMI) (HR: 0.89 with 95% confidence interval CI 0.78, 1.02, P = 0.1), HF (HR: 0.92 with 95% CI 0.71, 1.20, P = 0.54), and all-cause mortality (HR: 0.97 with 95% CI 0.85, 1.10, P = 0.63). Secondary endpoints-including major adverse cardiovascular events (MACE), cardiovascular death, stroke, and revascularization-were neutral (P > 0.05). TSA boundaries were not crossed, and meta-regression identified no significant effect modifiers. Evidence certainty was rated low to moderate. CONCLUSIONS: Among patients with MI and preserved LVEF, β-blockers did not reduce mortality or ischemic or HF events. Routine long-term use offers no prognostic advantage and should be reserved for specific indications such as reduced LVEF, angina, arrhythmia, or hypertension. REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO) identifier no. CRD420251175415.
Awashra et al. (Thu,) conducted a meta-analysis in Myocardial Infarction without reduced ejection fraction (n=23,524). Beta-blockers vs. No beta-blockers was evaluated on All-Cause Mortality (RR 0.98, 95% CI 0.87-1.11). In patients with myocardial infarction without reduced ejection fraction, beta-blockers did not significantly reduce the risk of all-cause mortality compared to no beta-blockers (RR 0.98).