Key result
Beta-blockers show no benefit post-MI with preserved LVEF, but reduce events in mildly reduced LVEF.
Why the study?
Does beta-blocker therapy reduce death, reinfarction, or heart failure in patients after myocardial infarction with preserved or mildly reduced LVEF?
Does beta-blocker therapy reduce death, reinfarction, or heart failure in patients after myocardial infarction with preserved or mildly reduced LVEF?
Routine beta-blocker therapy is no longer justified after an uncomplicated myocardial infarction with preserved LVEF (≥50%), but remains beneficial for patients with mildly reduced (40–49%) or reduced LVEF.
Answers are grounded in this paper and cite their sources.
May not support routine beta-blockers post-MI with preserved LVEF; leaves open dedicated RCTs to clarify subgroup effects.
Purpose of Review For four decades, almost every patient leaving hospital after a myocardial infarction (MI) received a beta-blocker, a habit built on trials from before the reperfusion era. This review asks which patients still need one. Following the SANRA criteria, we searched PubMed/MEDLINE, Scopus, Web of Science and Cochrane CENTRAL (1 August–1 October 2026) and synthesised randomised trials, their prespecified secondary analyses and individual patient data (IPD) analyses. Recent Findings Seven randomised trials, two IPD analyses and three secondary analyses were included. In 17,801 patients with preserved left ventricular ejection fraction (LVEF 50% or more), beta-blockers did not reduce death, reinfarction or heart failure (hazard ratio [HR] 0.97, 95% CI 0.87–1.07). In 1885 patients with mildly reduced LVEF (40–49%), they reduced this composite (HR 0.75, 95% CI 0.58–0.97). Trials of stopping long-term treatment disagreed: ABYSS failed to show non-inferiority, whereas SMART-DECISION showed it. An exploratory sex analysis of REBOOT raised the possibility of harm in women with preserved LVEF, which still needs confirmation. All trials were open-label. Summary Routine beta-blockade is no longer justified after an uncomplicated MI with preserved LVEF. It remains appropriate for reduced or mildly reduced LVEF, heart failure, arrhythmia, angina and hard-to-control hypertension. Stopping should follow shared decision-making rather than happen abruptly. Blinded trials in women, older adults and patients outside Europe and East Asia are still needed.
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Himat et al. (2026) conducted a review in Myocardial infarction (n=17,801). Beta-blocker therapy vs. No beta-blocker or discontinuation of long-term beta-blocker therapy was evaluated on Composite of death, reinfarction, or heart failure (HR 0.97, 95% CI 0.87-1.07). Beta-blockers did not reduce death, reinfarction, or heart failure in post-MI patients with preserved LVEF ≥50%, but reduced events in mildly reduced LVEF.
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