Key result
Long-term beta-blockers linked to ~26% lower post-STEMI mortality, but benefit disappears in RCTs.
Why the study?
The long-term impact of beta-blocker therapy on all-cause mortality and cardiovascular outcomes in STEMI patients continuing therapy for at least 1 year after discharge remains uncertain.
Does long-term beta-blocker therapy reduce all-cause mortality and cardiovascular outcomes in patients with STEMI in the contemporary reperfusion era?
Meta-Analysis (n=270,566)
Yes
Does long-term beta-blocker therapy reduce all-cause mortality and cardiovascular outcomes in patients with STEMI in the contemporary reperfusion era?
Routine, indefinite beta-blocker therapy appears to offer limited long-term mortality benefit in patients with uncomplicated STEMI and preserved ejection fraction in the contemporary reperfusion era.
Answers are grounded in this paper and cite their sources.
Does not support routine indefinite beta-blockers after STEMI; challenges observational mortality data and leaves open need for contemporary RCTs.
Aims: This meta-analysis assessed the long-term impact of beta-blocker therapy on all-cause mortality and cardiovascular outcomes in patients with ST-elevation myocardial infarction (STEMI) who continued beta-blocker use for a minimum of 1 year after hospital discharge. Methods: Electronic databases were searched through September 2024 to identify studies comparing long-term outcomes in patients treated with beta-blockers versus those untreated. A random-effects model was used to estimate Hazard Ratios (HRs) with 95% confidence intervals (CIs). Results: = 0.22], myocardial infarction, hospitalization for heart failure, or revascularization. Conclusion: Long-term beta-blocker use is associated with a significant reduction in all-cause mortality among STEMI patients, though this benefit was not seen in RCTs. Effects on other cardiovascular outcomes remain uncertain, highlighting the need for further large-scale trials.
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Maryam et al. (2026) conducted a meta-analysis in ST-elevation myocardial infarction (STEMI) (n=270,566). Beta-blocker therapy vs. Placebo or no beta-blocker treatment was evaluated on All-cause mortality (HR 0.74, 95% CI 0.66, 0.83, p=<0.00001). Long-term beta-blocker therapy was associated with a 26% reduction in all-cause mortality among post-STEMI patients, though this benefit was driven by observational studies and not seen in randomized controlled trials.
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