β-blocker and clinical outcomes in patients after myocardial infarction: a systematic review and meta-analysis
Related Experiment Video
Updated: Jan 18, 2026
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
Wenxing Yang1, Xuehong Sun2, Yushu Zhang2
1Department of Physiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China.
Insights
Beta-blockers reduce mortality after acute myocardial infarction (AMI), especially in patients with reduced ejection fraction (EF). However, their long-term benefits are less clear for patients with comorbidities or preserved EF.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- Current guidelines recommend beta-blocker therapy post-acute myocardial infarction (AMI).
- Large-scale observational studies present conflicting findings on beta-blocker efficacy in heterogeneous AMI populations.
- A systematic review and meta-analysis were conducted to clarify the long-term impact of beta-blockers in AMI.
Purpose of the Study:
- To quantify the long-term therapeutic impact of beta-blocker therapy in diverse acute myocardial infarction (AMI) patient populations.
- To systematically review and meta-analyze published observational studies on beta-blocker use after AMI.
- To evaluate the effect of beta-blockers on mortality and major adverse cardiac events (MACE) in AMI survivors.
Main Methods:
- Comprehensive database searches (PubMed, Embase, Cochrane, Web of Science) for studies from 2000-2025.
- Meta-analysis of 34 observational studies involving 233,303 AMI patients.
- Stratified analysis by study type, ejection fraction (EF), sample size, follow-up duration, and patient characteristics (revascularization, STEMI, comorbidities).
Main Results:
- Beta-blockers significantly reduced all-cause mortality (OR=0.73) and cardiac death (OR=0.79) in post-AMI patients.
- No significant effect of beta-blockers on major adverse cardiac events (MACE) was observed overall.
- Benefits were most pronounced in patients with reduced ejection fraction (EF), showing reduced all-cause death, cardiac death, and MACE.
Conclusions:
- Beta-blockers demonstrate potential long-term clinical benefits for acute myocardial infarction (AMI) patients, particularly those with reduced ejection fraction (EF).
- The conclusive benefit of beta-blockers is less certain in AMI patients with specific comorbidities or preserved EF.
- Further research may be needed to refine beta-blocker recommendations based on patient subgroups.
Background And Objective:
While current clinical guidelines generally advocate for beta-blocker therapy following acute myocardial infarction (AMI), conflicting findings have surfaced through large-scale observational studies and meta-analyses. We conducted this systematic review and meta-analysis of published observational studies to quantify the long-term therapeutic impact of beta-blocker across heterogeneous AMI populations.
Methods:
We conducted comprehensive searches of the PubMed, Embase, Cochrane, and Web of Science databases for articles published from 2000 to 2025 that examine the link between beta-blocker therapy and clinical outcomes (last search update: March 1, 2025). We used the odds ratio (OR) with its 95% confidence interval (95% CI) to evaluate the effect of beta-blocker therapy on all-cause mortality, cardiac death, or major adverse cardiac events (MACE) in AMI patients. Our analysis stratified these effects by study type, ejection fraction (EF), sample size, follow-up duration, and patient characteristics including primary coronary revascularization, ST-segment elevation status, and comorbidities.
Results:
This meta-analysis incorporated 34 observational studies covering 233,303 AMI patients. Our results showed beta-blockers reduced all-cause (OR = 0.73, 95% CI = 0.64-0.82) and cardiac mortality (OR = 0.79, 95% CI = 0.70-0.89) in post-AMI patients, with no significant effect on MACE. In these patients, post-PCI and STEMI patients, beta-blockers lowered all-cause mortality but not MACE risk. Subgroup analysis revealed that beta-blockers decreased all-cause death in post-AMI patients with diabetes and COPD, but not in those with hypertension and AF. Stratified by EF, beta-blockers were beneficial for all-cause death (OR = 0.75, 95% CI = 0.60-0.93), cardiac death (OR = 0.72, 95% CI = 0.56-0.92), and MACE (OR = 0.85, 95% CI = 0.76-0.96) in post-AMI patients with reduced EF and only decreased all-cause death in those with preserved EF.
Conclusions:
Our meta-analysis suggests beta-blockers may offer long-term clinical benefits to AMI patients, particularly those with reduced EF. However, this is not conclusive for AMI patients with comorbidities or preserved EF.
Related Concept Videos
01:27Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers
01:22Heart Failure Drugs: β-Blockers
01:28Antihypertensive Drugs: Types of β-Blockers
01:16Antianginal Drugs: Nitrates and β-Blockers
Organic nitrates, such as nitroglycerin, play a pivotal role. Once metabolized, they liberate nitric oxide, a molecular marvel. Nitric oxide triggers guanylyl cyclase and augments cGMP production. This biochemical cascade orchestrates the relaxation of vascular smooth muscles, ushering in vasodilation and enhancing coronary blood flow....
01:31Adrenergic Antagonists: ɑ and β-Receptor Blockers
01:25Adrenergic Antagonists: Chemistry and Classification of β-Receptor Blockers