Beta-Blocker Use in Post-Myocardial Infarction Patients With Preserved Ejection Fraction: A Review

Beta-adrenergic blockers [beta-blockers (BBs)] have long been a cornerstone of therapy after myocardial infarction (MI) based on early trials showing reduced mortality. However, their role in patients who recover from MI with preserved left ventricular ejection fraction (LVEF) is increasingly debated in the modern era of reperfusion and contemporary medical therapy. We reviewed randomized controlled trials, observational studies, meta-analyses, and clinical guidelines regarding BB use in post-MI patients without left ventricular systolic dysfunction (normal LVEF) and preserved ejection fraction (EF), acknowledging a lack of evidence in this subgroup. In patients with MI without reduced LVEF, long-term BB therapy has not demonstrated clear outcome benefits in the contemporary era. BBs remain indicated for those with reduced LVEF (≤40%), heart failure, arrhythmias, or ongoing ischemia, but routine continuation in all post-MI patients with normal EF may be unnecessary. Ongoing trials should further clarify which patients benefit from BBs after MI. Clinicians should individualize decisions, considering potential side effects and patient comorbidities, and current guidelines suggest re-evaluating the need for BBs in stable post-MI patients with preserved EF.