What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Acute myocardial infarction. Intervention: Heart rate-lowering drugs vs. Placebo or less intensive treatment. Primary outcome: Mortality.

What question did this study set out to answer?

This meta-analysis investigates how heart rate-lowering treatment affects mortality in acute myocardial infarction during different reperfusion periods.

June 3, 2026

Mortality Benefit of Hr-Lowering Treatment After Acute Myocardial Infarction Across Pre-Reperfusion and Reperfusion Eras: A Meta-Analysis

Key Result

Heart rate-lowering treatment after acute myocardial infarction significantly reduced mortality across 20 trials in both the pre-reperfusion and reperfusion eras.

Key Points

This meta-analysis investigates how heart rate-lowering treatment affects mortality in acute myocardial infarction during different reperfusion periods.
Included randomized controlled trials comparing heart rate-lowering drugs with placebo or less intensive treatments.
Calculated risk ratios and 95% confidence intervals using a random-effects model.
Analyzed 20 trials: 14 in the pre-reperfusion era and 6 in the reperfusion era.
In the pre-reperfusion era, heart rate reduction significantly decreased mortality.
During the reperfusion era, a significant crude mortality reduction was noted, becoming more pronounced after heart rate standardization.
Beta-blockers showed a meaningful survival advantage in both eras.

Study Design

Type

Meta-Analysis

Structured PICO

Does post-MI heart rate-lowering treatment reduce mortality in patients after acute myocardial infarction across pre-reperfusion and reperfusion eras?

Population

Meta-analysis of 20 randomized controlled trials evaluating post-MI heart rate-lowering drugs with a mean follow-up of 1.6 to 1.8 years.

Intervention

Post-MI heart rate-lowering drugs (beta-blockers)

Comparator

Placebo or less intensive treatment

Outcome

Mortalityhard clinical

Heart rate-lowering therapy with beta-blockers after acute myocardial infarction provides a significant mortality benefit in both the historical pre-reperfusion and modern reperfusion eras.

Abstract

Objective: Beta-blocker therapy has proven to be beneficial for the treatment of acute myocardial infarction (MI), by reducing post-MI mortality, primarily through lowering heart rate (HR), preventing life-threatening arrhythmias. However, it remains unclear whether the mortality benefit differs between the distinct pre-reperfusion and reperfusion periods. This meta-analysis aimed to evaluate whether the effect of HR-lowering on mortality varies according to the reperfusion era.Design and method: Randomized controlled trials (RCT) from the PubMed and the Cochrane Library comparing post-MI HR-lowering drugs with placebo or less intensive treatment were included. Risk ratios and 95% confidence intervals (CIs) were calculated using a random-effects model. Standardization of the risk estimates was considered a HR difference of 10 bpm. Results: A total of 20 post-MI trials were analyzed. Of them, 14 trials were performed in the pre-reperfusion era while 6 trials in the reperfusion one. The mean follow-up period in the pre-reperfusion versus reperfusion era was 1.6 and 1.8 years, respectively. The mean HR achieved between the two groups was 66.4 versus 69.5 bpm, respectively. In the pre-reperfusion era, HR reduction significantly decreased mortality, with a similar effect after HR standardization of 10 bpm. Likewise, during the reperfusion era, the crude mortality reduction was significant and became more pronounced after HR standardization. Conclusions: This meta-analysis demonstrated that HR lowering treeatment after acute MI is associated with a significant reduction in mortality in both the pre-reperfusion and reperfusion eras. Although advances in reperfusion strategies have altered the clinical context of MI management, beta-blockers continue to confer a meaningful survival advantage, which appears at least comparable in the reperfusion era. These findings reinforce the ongoing role of beta-blocker therapy as an integral component of post-MI management.

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