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Beta-Blockers after Myocardial Infarction in Patients without Heart Failure
John Munkhaugen1,2, Anna Meta D Kristensen3, Sigrun Halvorsen4,5
1Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway.
The New England Journal of Medicine
|September 1, 2025
Summary
Beta-blocker therapy after myocardial infarction significantly reduced the risk of death or major adverse cardiovascular events in patients with preserved ejection fraction. This finding supports beta-blocker use in post-myocardial infarction care.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- Established beta-blocker evidence predates modern reperfusion and secondary prevention strategies.
- Current guidelines require updated evidence for post-myocardial infarction (MI) management.
Purpose of the Study:
- To evaluate the long-term efficacy of beta-blocker therapy after MI.
- To assess the impact of beta-blockers on mortality and major adverse cardiovascular events (MACE) in patients with left ventricular ejection fraction (LVEF) ≥40%.
Main Methods:
- Open-label, randomized trial with blinded endpoint evaluation in Denmark and Norway.
- 5574 patients with MI and LVEF ≥40% randomized 1:1 to beta-blockers or no beta-blockers within 14 days.
- Primary endpoint: composite of all-cause death or MACE (MI, revascularization, stroke, heart failure, ventricular arrhythmias).
Main Results:
- Median follow-up of 3.5 years.
- Beta-blocker group (n=2783) had 14.2% primary endpoint events vs. 16.3% in no-beta-blocker group (n=2791) (HR 0.85; P=0.03).
- Reduced risk of MI (HR 0.73) observed with beta-blockers; no significant differences in all-cause death or other MACE components. Safety outcomes were similar.
Conclusions:
- Beta-blocker therapy significantly lowers the risk of death or MACE in MI patients with LVEF ≥40%.
- Results support continued use of beta-blockers as a cornerstone of post-MI secondary prevention.
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