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%).
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%.
p-value: p== 0.031
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. Results: = 0.031), with no between-trial heterogeneity. 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.
Zhao et al. (Tue,) 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%).