Related Experiment Video

Updated: May 8, 2026

Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
14:35

Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs

Published on: April 17, 2021

Beta-blockers after myocardial infarction with preserved or mildly reduced ejection fraction: existing evidence,

Shujuan Zhao1, Chiwei Guo1, Haixia Cai1

  • 1Department of Pharmacy, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou, Henan, China.

Frontiers in Pharmacology
|May 7, 2026
PubMed

Insights

Beta-blockers (BBs) are not beneficial for secondary prevention after myocardial infarction (MI) in patients with preserved ejection fraction (EF). However, BBs may offer benefits for those with mildly reduced EF.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Pharmacology

Background:

  • Beta-blockers (BBs) have been a standard treatment for secondary prevention after myocardial infarction (MI).
  • Recent evidence questions long-term BB use in patients with preserved or mildly reduced left ventricular ejection fraction (LVEF).
  • This is particularly relevant in the context of modern treatments like percutaneous coronary intervention and guideline-directed medical therapy.

Purpose of the Study:

  • To evaluate the efficacy and safety of beta-blocker (BB) therapy in patients post-myocardial infarction (MI).
  • To assess outcomes stratified by left ventricular ejection fraction (LVEF) in contemporary practice.
  • To review current North American and European guidelines regarding BB use after MI.

Main Methods:

  • A systematic review and meta-analysis of three randomized controlled trials and two meta-analyses.
  • Evaluation of BB therapy in post-MI patients with preserved or mildly reduced LVEF.
  • Critical appraisal of trial designs, endpoints, outcomes, and guideline recommendations.

Main Results:

  • In patients with preserved LVEF (≥50%), BB therapy showed no significant reduction in death, MI, or heart failure (P = 0.54).
  • In patients with mildly reduced LVEF (40%-49%), BB therapy was associated with a 25% relative risk reduction in the composite endpoint (P = 0.031) without heterogeneity.
  • Safety profiles were similar between BB and no-BB groups.

Conclusions:

  • An EF-stratified approach to BB therapy post-MI is supported by contemporary evidence.
  • Routine long-term BB use may not be justified for patients with preserved LVEF (≥50%) unless other indications exist.
  • BB therapy may be considered for patients with mildly reduced LVEF (40%-49%) after MI.
Abstract

Keywords:
LVEFbeta-blockersguideline-directed medical therapymyocardial infarctionsecondary prevention

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