The routine use of beta-blockers following myocardial infarction (MI) in patients with a preserved ejection fraction has been a topic of clinical uncertainty. A new large-scale, individual-patient data meta-analysis from the Beta-Blocker Trialists’ Collaboration Study Group, combining five major trials, has found no significant benefit for this patient population.¹
Methodology
This meta-analysis pooled individual-patient data from five open-label, randomised trials: REBOOT, REDUCE-AMI, BETAMI, DANBLOCK, and CAPITAL-RCT. The study included 17,801 patients with a recent MI, a left ventricular ejection fraction (LVEF) of 50% or greater, and no other standard indications for beta-blocker therapy.
Patients were assigned to receive either long-term beta-blocker therapy (n=8,831) or no beta-blocker therapy (n=8,970). The primary endpoint was a composite of death from any cause, subsequent MI, or heart failure.
Results
Over a median follow-up of 3.6 years, the primary endpoint occurred in 717 patients (8.1%) in the beta-blocker group compared to 748 patients (8.3%) in the no-beta-blocker group. The difference was not statistically significant (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.87 to 1.07; P=0.54).
Analysis of the individual components of the primary endpoint also showed no significant benefit with beta-blocker therapy. Death from any cause occurred in 335 patients in the beta-blocker group and 326 in the control group (HR, 1.04; 95% CI, 0.89 to 1.21). The incidence of MI was 360 versus 407, respectively (HR, 0.89; 95% CI, 0.77 to 1.03), and the incidence of heart failure was 75 versus 87 (HR, 0.87; 95% CI, 0.64 to 1.19).
In Practice
The findings suggest that beta-blocker therapy does not reduce the incidence of death, MI, or heart failure in MI patients with a preserved LVEF of 50% or more. These results may prompt a re-evaluation of clinical guidelines regarding the routine, long-term prescription of beta-blockers in this specific post-MI patient cohort.
This study was funded by the Centro Nacional de Investigaciones Cardiovasculares Carlos III, the Swedish Research Council, the Swedish Heart and Lung Association, the Region of Stockholm, the South-Eastern Norway Regional Health Authority, the Research Council of Norway, the Danish Heart Foundation, the Novo Nordisk Foundation, and the Research Institute for Production Development (Kyoto, Japan).
Disclaimer
The information presented in this article is for educational purposes only. Any quotes included reflect the opinions of the individual quoted, and do not necessarily reflect the views of the publisher. The publisher does not guarantee the accuracy or completeness of the content and accepts no responsibility for any errors, or any consequences arising from its use.
References
1. Kristensen AMD, Rossello X, Atar D, et al. Beta-Blockers after Myocardial Infarction with Normal Ejection Fraction. N Engl J Med 2026;394:540-550. https://doi.org/10.1056/NEJMoa2512686