Key result
Routine beta-blockers lack benefit post-MI in preserved LVEF but remain reasonable for mildly reduced LVEF.
Why the study?
Contemporary randomized evidence has challenged long-term beta-blocker use after myocardial infarction in patients with preserved or mildly reduced LVEF in the modern treatment era.
Does beta-blocker therapy improve outcomes in post-myocardial infarction patients with preserved or mildly reduced ejection fraction?
Does beta-blocker therapy improve outcomes in post-myocardial infarction patients with preserved or mildly reduced ejection fraction?
Routine long-term beta-blocker prescription may no longer be justified for post-MI patients with LVEF ≥50%, but may remain reasonable for those with LVEF 40-49%.
Answers are grounded in this paper and cite their sources.
May prompt reevaluation of routine beta-blockers post-MI with LVEF ≥50%; challenges consensus but leaves need for dedicated RCTs open.
Background: For several decades, beta-blockers (BBs) have served as a cornerstone in the secondary prevention following myocardial infarction (MI). However, contemporary randomized evidence has challenged the long-term BB use in patients with preserved or mildly reduced left ventricular ejection fraction (LVEF) in the era of percutaneous coronary intervention and comprehensive guideline-directed medical therapy. Methods: We summarized evidence from three randomized controlled trials and two contemporary meta-analyses, evaluating BB therapy in post-MI patients with preserved or mildly reduced LVEF. We critically appraised trial designs, endpoints, and outcomes stratified by LVEF, and reviewed current guideline recommendations from North American and European perspectives. Safety profiles were comparable between BB and no-BB groups across all trials. Conclusion: Contemporary evidence supports an EF-stratified approach to BB therapy after MI. Routine long-term BB prescription may no longer be justified for patients with preserved LVEF (≥50%) without other indications, whereas BB therapy may be reasonable to consider for those with mildly reduced LVEF (40%-49%). These findings support an EF-stratified approach to long-term BB use after MI in contemporary practice.
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Zhao et al. (2026) conducted a review in Myocardial infarction with preserved or mildly reduced ejection fraction. Beta-blockers vs. No beta-blockers was evaluated (p== 0.031). Routine long-term beta-blocker therapy may no longer be justified for post-MI patients with preserved LVEF (≥50%), but may be reasonable for those with mildly reduced LVEF (40%-49%).
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