Beta-Blocker Discontinuation After Myocardial Infarction: A Systematic Review and Meta-Analysis

Beta-blockers after myocardial infarction (MI) are being questioned, specifically among persons with preserved left ventricular ejection fraction (LVEF). This raises consideration for beta-blocker discontinuation.

The objective of this study was to conduct a systematic review and meta-analysis examining the effects of discontinuation vs continuation of beta-blockers after MI.

We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Google Scholar, Epistemonikos from inception to September 11, 2025. Eligible studies were randomized controlled trials and nonrandomized studies among adults ≥18 years. Outcomes included mortality and major adverse cardiovascular (CV) events (MACE), as well as its components. We performed meta-analyses using an inverse-variance random-effects model and evaluated certainty of evidence using Grading of Recommendations, Assessment, Development, and Evaluation.

We screened 4,103 titles/abstracts, and 10 studies were eligible (1 randomized controlled trial, 9 observational studies; N = 121,114). Eight studies involved patients with LVEF >40% and/or without heart failure. Compared with beta-blocker continuation, discontinuation might not be associated with increased risk of mortality (HR: 1.11; 95% CI: 0.96-1.28; 8 studies; low certainty evidence). Discontinuation might be associated with increased risk of MACE compared with continuation (HR: 1.12; 95% CI: 1.01-1.24; 7 studies; low certainty; driven by increased risk of CV hospitalizations) but might not be associated with an increased risk of MI (HR: 1.39; 95% CI: 0.95-2.04; 5 studies; low certainty).

Among post-MI patients with LVEF >40% and without heart failure, beta-blocker discontinuation might not increase risk of mortality or MI, though there may be an increased risk of MACE primarily due to CV hospitalizations.