Beta-Blockers After Myocardial Infarction Without Reduced Ejection Fraction: A Meta-Analysis of Kaplan-Meier...

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.

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.

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.

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.

International Prospective Register of Systematic Reviews (PROSPERO) identifier no. CRD420251175415.