Beta-blockers after myocardial infarction without reduced ejection fraction: A meta-analysis of kaplan-meier reconstructed individual patient data

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Background: The long-term benefit of beta-blockers (β-blockers) after myocardial infarction (MI) in patients with preserved left-ventricular ejection fraction (LVEF ≥ 40%) remains uncertain in the modern reperfusion era. Earlier trials showed mortality benefits, but contemporary therapies may have altered their effect.

Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) comparing β-blockers versus no β-blockers in adults with MI and LVEF ≥ 40%. PubMed, Scopus, Web of Science, and Cochrane CENTRAL were searched through October 2025. Primary outcomes were all-cause mortality, recurrent MI, and heart failure (HF). Individual patient data (IPD) were reconstructed from Kaplan-Meier curves for time-to-event analysis, and pooled risk ratios (RRs) and hazard ratios (HRs) were estimated using random-effects models. Trial sequential analysis (TSA), meta-regression, and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) certainty assessments were performed.

Results: Five RCTs (n = 23,524 patients) met inclusion criteria. β-Blockers did not significantly reduce recurrent acute myocardial infarction (AMI) (HR: 0.89 with 95% confidence interval [CI 0.78, 1.02], P = 0.1), HF (HR: 0.92 with 95% CI [0.71, 1.20], P = 0.54), and all-cause mortality (HR: 0.97 with 95% CI [0.85, 1.10], P = 0.63). Secondary endpoints-including major adverse cardiovascular events (MACE), cardiovascular death, stroke, and revascularization-were neutral (P > 0.05). TSA boundaries were not crossed, and meta-regression identified no significant effect modifiers. Evidence certainty was rated low to moderate.

Conclusions: Among patients with MI and preserved LVEF, β-blockers did not reduce mortality or ischemic or HF events. Routine long-term use offers no prognostic advantage and should be reserved for specific indications such as reduced LVEF, angina, arrhythmia, or hypertension.

Type

Article

PubMed ID

41714516

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