The role of long-term beta-blocker therapy following a myocardial infarction (MI) in patients without heart failure remains a subject of clinical debate, particularly in the modern era of reperfusion and secondary prevention. The BETAMI–DANBLOCK trial sought to address this evidence gap by evaluating the efficacy of beta-blockers in this specific patient population.¹

BETAMI–DANBLOCK was an open-label, randomised trial with blinded endpoint evaluation conducted across centres in Denmark and Norway.¹ A total of 5,574 patients with a recent MI and a left ventricular ejection fraction (LVEF) of 40% or higher were enrolled.

Participants were assigned in a 1:1 ratio to receive either long-term beta-blocker therapy or no beta-blocker therapy. The primary endpoint was a composite of death from any cause or major adverse cardiovascular events (MACE), defined as new MI, unplanned coronary revascularisation, ischaemic stroke, heart failure, or malignant ventricular arrhythmias.

After a median follow-up of 3.5 years, the primary endpoint occurred in 394 patients (14.2%) in the beta-blocker group compared to 454 patients (16.3%) in the no-beta-blocker group (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.75 to 0.98; P=0.03).¹

Analysis of the individual components revealed that the composite benefit was primarily driven by a reduction in subsequent MI, which occurred in 5.0% of the beta-blocker group versus 6.7% of the no-beta-blocker group (HR, 0.73; 95% CI, 0.59 to 0.92). There was no significant difference between the groups for death from any cause (4.2% vs 4.4%, respectively) or other secondary endpoints. Safety outcomes were comparable between the two arms.

The findings from the BETAMI–DANBLOCK trial suggest that among patients with a recent MI and preserved LVEF, long-term beta-blocker therapy leads to a lower risk of the composite of death or MACE than no beta-blocker therapy.¹ This result contributes to a growing and complex body of evidence. A subsequent individual patient data meta-analysis, which included BETAMI–DANBLOCK and other similar trials, did not find a significant reduction in the primary composite endpoint for patients with an LVEF ≥50%.² These differing results highlight the ongoing need to refine patient selection for long-term beta-blocker therapy post-MI.

This study was funded by the Health South-East research program in Norway, the Research Council of Norway, the Danish Heart Foundation, and the Novo Nordisk Foundation.

References

1. Munkhaugen J, Kristensen AMD, Halvorsen S, et al. Beta-Blockers after Myocardial Infarction in Patients without Heart Failure. N Engl J Med 2025;393:1901-1911. https://doi.org/10.1056/NEJMoa2505985

2. Kristensen AMD, Rossello X, Atar D, et al. Beta-Blockers after Myocardial Infarction with Normal Ejection Fraction. N Engl J Med. Published online November 13, 2025. https://doi.org/10.1056/NEJMoa2512686

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