Long-term beta-blocker therapy in post-MI patients with preserved LVEF did not significantly reduce all-cause mortality after adjusting for methodological biases (HR 0.79; 95% CI 0.62-1.02; p=0.07).
Meta-Analysis (n=85,607)
Does prolonged beta-blocker therapy reduce mortality and cardiovascular events in post-MI patients with preserved LVEF?
Long-term beta-blocker therapy does not confer significant mortality or cardiovascular benefits in post-MI patients with preserved LVEF, challenging current guideline recommendations.
Hazard Ratio: 0.81 (95% CI 0.67–0.98)
p-value: p=0.03
Abstract Background Beta-blockers (BB) have been widely recommended for patients post-myocardial infarction (MI) due to their benefits in reducing mortality and adverse cardiovascular events. However, their long-term efficacy in patients with preserved left ventricular ejection fraction (LVEF) remains uncertain. This systematic review and meta-analysis aimed to evaluate the impact of prolonged BB use on clinical outcomes in this specific population. Methods Following PRISMA guidelines, a systematic literature search was conducted in PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to September 1, 2024. Eligible studies included randomized controlled trials (RCTs) and observational cohort studies comparing BB versus placebo or no treatment in post-MI patients with preserved LVEF. Primary outcomes assessed were all-cause mortality, cardiovascular mortality, major adverse cardiac events (MACE), reinfarction, hospitalization for heart failure (HF), and stroke. Hazard ratios (HR) and 95% confidence intervals (CI) were pooled using a random-effects model. Sensitivity and subgroup analyses were performed to account for potential biases. Results A total of 11 studies, encompassing 85,607 patients (76.8% receiving BB), met the inclusion criteria. The global analysis demonstrated a significant reduction in all-cause mortality in BB users (HR 0.81; 95% CI 0.67–0.98; p=0.03). However, sensitivity analyses adjusting for methodological biases negated this significance (HR 0.79; 95% CI 0.62–1.02; p=0.07). There were no significant differences in cardiovascular mortality (HR 0.83; 95% CI 0.57–1.20; p=0.21), reinfarction (HR 0.94; 95% CI 0.78–1.13; p=0.52), hospitalization for HF (HR 1.02; 95% CI 0.87–1.20; p=0.78), or stroke incidence (HR 1.04; 95% CI 0.82–1.30; p=0.73). Heterogeneity was high for some endpoints (I² = 60%), particularly for stroke outcomes. Conclusion This meta-analysis suggests that long-term BB therapy does not confer significant mortality or cardiovascular benefits in post-MI patients with preserved LVEF. These findings challenge current guideline recommendations advocating routine BB use in this population and highlight the need for individualized therapy. Ongoing trials, such as DANBLOCK, BETAMI, and REBOOT, will further clarify the role of BB in this subset of patients.
Gomes et al. (Sat,) conducted a meta-analysis in post-myocardial infarction with preserved left ventricular ejection fraction (n=85,607). Beta-blockers vs. placebo or no treatment was evaluated on all-cause mortality (HR 0.81, 95% CI 0.67-0.98, p=0.03). Long-term beta-blocker therapy in post-MI patients with preserved LVEF did not significantly reduce all-cause mortality after adjusting for methodological biases (HR 0.79; 95% CI 0.62-1.02; p=0.07).