Key result
Beta-blockers fail to reduce death or recurrent MI after recent MI with preserved LVEF.
Why the study?
Early trials demonstrating mortality benefit from beta-blockers post-MI predated modern therapies, and recent observational studies have not shown an association with mortality in patients with preserved EF.
Do beta-blockers improve cardiovascular outcomes in patients with myocardial infarction and preserved ejection fraction?
RCT (n=5,020)
Open-label
1:1
Yes
Do beta-blockers improve cardiovascular outcomes in patients with myocardial infarction and preserved ejection fraction?
Effect estimate: HR 0.96 (95% CI 0.79-1.16)
Absolute Event Rate: 7.9% vs 8.3%
The routine use of beta-blockers in post-MI patients with preserved ejection fraction may not provide a mortality benefit in the contemporary era of medical therapy.
May not reduce post-MI mortality with contemporary therapy; leaves open need for new randomized trials.
IMORTANT Despite substantial progress in medical and interventional therapy, coronary artery disease (CAD) remains the leading cause of death in the United States. 1 Early trials showed mortality benefit from beta-blockers after myocardial infarction (MI).However, these studies predated the advent of aspirin, percutaneous coronary intervention (PCI), statins, and P2Y12 inhibitors. Recent observational studies have not found an association between beta-blockers and mortality for patients with preserved ejection fraction (EF) post-MI. 2 The ABYSS trial found that discontinuing beta-blockers was associated with higher rates of adverse cardiac events; however, the number of deaths and MI was similar between groups and the difference in outcomes was driven by cardiac hospitalization. 3
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Beaty et al. (2026) conducted an RCT in Myocardial infarction with preserved ejection fraction (n=5,020). Beta-blockers (metoprolol or bisoprolol) vs. Usual care was evaluated on Composite of death from any cause or recurrent myocardial infarction (HR 0.96, 95% CI 0.79-1.16). Beta-blockers did not reduce the risk of death or recurrent myocardial infarction compared to usual care in patients with recent myocardial infarction and preserved ejection fraction (HR 0.96).
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