A large-scale meta-analysis of individual patient data has found that beta-blocker therapy does not reduce the risk of major adverse cardiovascular events in patients with a preserved left ventricular ejection fraction (LVEF) following a myocardial infarction (MI).¹ The findings, from the Beta-Blocker Trialists’ Collaboration Study Group, question the routine use of this drug class in this specific patient population.
The study was an individual-patient-level meta-analysis of five open-label, randomised controlled trials: REBOOT, REDUCE-AMI, BETAMI, DANBLOCK, and CAPITAL-RCT. The analysis included 17,801 patients with a recent MI, an LVEF of at least 50%, and no other indications for beta-blocker therapy. Patients were randomly assigned to receive either a beta-blocker (n=8,831) or no beta-blocker (n=8,970). The primary endpoint was a composite of death from any cause, subsequent MI, or heart failure. Secondary endpoints included the individual components of the primary composite endpoint.
Over a median follow-up of 3.6 years, the primary endpoint occurred in 717 patients (8.1%) in the beta-blocker group compared with 748 patients (8.3%) in the no-beta-blocker group, a difference that was not statistically significant (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.87 to 1.07; P=0.54).
Analysis of the secondary endpoints also showed no significant benefit with beta-blocker therapy. Death from any cause occurred in 335 patients in the treatment 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 heart failure occurred in 75 versus 87 patients (HR, 0.87; 95% CI, 0.64 to 1.19).
These results suggest that for patients who have had a myocardial infarction but have a preserved LVEF and no other compelling reasons for treatment, such as heart failure or arrhythmia, the routine prescription of beta-blockers may not be warranted. The investigators concluded that in this meta-analysis, "beta-blocker therapy did not reduce the incidence of death from any cause, myocardial infarction, or heart failure in patients with an LVEF of at least 50% after myocardial infarction without other indications for beta-blockers."¹
This study was funded by Centro Nacional de Investigaciones Cardiovasculares Carlos III, the Swedish Research Council, the South-Eastern Norway Regional Health Authority, the Danish Heart Foundation, and the Research Institute for Production Development.
References
1. Kristensen AMD, Rossello X, Atar D, et al. Beta-Blockers after Myocardial Infarction with Normal Ejection Fraction. N Engl J Med. Published online November 9, 2025. https://doi.org/10.1056/NEJMoa2512686.
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