Key result
Beta-blockers show no significant benefit for major cardiovascular events in AMI with LVEF ≥40%.
Why the study?
The association between beta-blocker therapy and major cardiovascular outcomes in AMI patients with preserved or mildly reduced LVEF was uncertain.
Does beta-blocker therapy reduce mortality, reinfarction, cardiovascular-related hospitalization, and other cardiovascular events in patients with acute myocardial infarction and preserved or mildly reduced ejection fraction?
Meta-Analysis (n=18,504)
Does beta-blocker therapy reduce mortality, reinfarction, cardiovascular-related hospitalization, and other cardiovascular events in patients with acute myocardial infarction and preserved or mildly reduced ejection fraction?
Hazard Ratio: 0.9 (95% CI 0.81–1.01)
Routine beta-blocker therapy does not significantly reduce composite cardiovascular outcomes in patients following an acute myocardial infarction who have preserved or mildly reduced ejection fraction.
OBJECTIVE To evaluate the association between beta-blocker therapy and major cardiovascular outcomes in patients with acute myocardial infarction (AMI) and preserved or mildly reduced left ventricular ejection fraction (LVEF). DESIGN Systematic review and meta-analysis of randomized clinical trials. SETTING A comprehensive search of five electronic databases was conducted using a predefined PICO strategy to identify published studies. Seven studies were selected and included in the meta-analysis. PARTICIPANTS Patients with AMI and preserved or mildly reduced LVEF who received beta-blocker therapy. INTERVENTION Use of beta-blockers. MAIN OUTCOME MEASURES Primary composite outcome including mortality, reinfarction, cardiovascular-related hospitalization, and other cardiovascular events. RESULTS This meta-analysis included four studies comprising a total of 18,504 patients with a history of AMI and an LVEF ≥ 40%. Among them, 2223 patients had mildly reduced LVEF, while 15,908 belonged to the preserved LVEF group. Beta-blocker therapy did not reduce the primary composite outcome (death, reinfarction, and hospitalization) in patients with LVEF ≥ 40% (hazard ratio [HR]: 0.90; 95% confidence interval [95% CI]: 0.81-1.01). Subsequent subgroup analyses showed that beta-blocker therapy did not reduce the primary composite outcome in patients with preserved LVEF (HR: 0.94; 95% CI: 0.87-1.03); however, in patients with mildly reduced LVEF, it was associated with a reduction in the same primary composite outcome (HR: 0.82; 95% CI: 0.70-0.97). CONCLUSIONS In this meta-analysis, beta-blocker use was not associated with a significant reduction in the primary composite outcome or in mortality or reinfarction. The association observed in patients with mildly reduced ejection fraction derives from a subgroup and should be interpreted with caution in the context of an overall neutral result.
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Neira-Chunga et al. (2026) conducted a meta-analysis in Acute myocardial infarction with preserved or mildly reduced left ventricular ejection fraction (n=18,504). Beta-blocker therapy was evaluated on Composite outcome of mortality, reinfarction, and cardiovascular-related hospitalization (HR 0.90, 95% CI 0.81-1.01). Beta-blocker therapy did not significantly reduce the primary composite outcome of death, reinfarction, and hospitalization in patients with AMI and LVEF ≥ 40% (HR 0.90; 95% CI 0.81-1.01).
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