Beta-Blockers in Patients with Myocardial Infarction and No Heart Failure: A Systematic Review and Meta-analysis of...

β-Blockers have an established role in patients with myocardial infarction (MI) and left ventricular ejection fraction (LVEF) <40%. In those with LVEF >40%, emerging new trials have inconsistent results. We conducted a meta-analysis to evaluate the outcomes of β-blocker therapy compared with no β-blocker therapy in patients with MI and LVEF >40%.

We searched PubMed, Embase, and CENTRAL for randomized controlled trials (RCTs) published after 2000. Meta-analyses estimated hazard ratio (HR) or risk ratio (RR) with 95% confidence intervals (CIs) using RevMan web.

Five RCTs (N = 19,826) met the inclusion criteria, with 9892 patients (49.8%) randomized to β-blockers and 9934 (50.2%) to no β-blockers. All trials enrolled patients with MI and LVEF >40%. Meta-analysis demonstrated that β-blockers were not associated with significant reduction in all-cause mortality (HR 0.98, 95% CI 0.85-1.13), cardiac mortality (HR 1.16, 95% CI 0.89-1.51), unplanned coronary revascularization (HR 1.01, 95% CI 0.87-1.17), or malignant ventricular arrhythmia (RR 0.87, 95% CI 0.51-1.48). β-Blockers were associated with a trend toward lower MI (HR 0.88, 95% CI 0.77-1.00) and new-onset heart failure (HF) (HR 0.82, 95% CI 0.63-1.07). β-Blockers were not associated with an increase in symptomatic atrioventricular block (HR 1.06, 95% CI 0.83-1.34) or stroke (RR 1.16, 95% CI 0.9-1.48).

In patients with MI with LVEF >40%, β-blockers were not associated with a significant effect on any outcome; β-blockers were associated with a trend toward lower MI and HF.

PROSPERO CRD420251139242.