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

Wade Thompson1, Nima Alaeiilkhchi1, Lisa M McCarthy2

  • 1Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada.

JACC. Advances
|June 18, 2026
PubMed

Insights

Discontinuing beta-blockers after myocardial infarction (MI) in patients with preserved ejection fraction may not increase mortality or MI risk. However, it might raise the risk of major adverse cardiovascular events (MACE), mainly due to hospitalizations.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Evidence-Based Medicine

Background:

  • Beta-blocker use post-myocardial infarction (MI) is debated, particularly in patients with preserved left ventricular ejection fraction (LVEF).
  • Consideration for beta-blocker discontinuation is increasing in this patient population.

Purpose of the Study:

  • To systematically review and meta-analyze the effects of beta-blocker discontinuation versus continuation after MI.
  • To assess the impact on mortality and major adverse cardiovascular (CV) events.

Main Methods:

  • Systematic search of multiple databases (MEDLINE, Embase, Cochrane, Google Scholar, Epistemonikos) up to September 11, 2025.
  • Inclusion of randomized controlled trials and nonrandomized studies in adults (≥18 years).
  • Meta-analysis using inverse-variance random-effects model; certainty of evidence assessed by Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

Main Results:

  • Ten studies (1 RCT, 9 observational; N=121,114) met eligibility criteria; 8 focused on patients with LVEF >40% and/or no heart failure.
  • Beta-blocker discontinuation showed no significant increase in mortality risk (HR: 1.11; low certainty evidence).
  • Discontinuation may increase MACE risk (HR: 1.12; low certainty), driven by CV hospitalizations, but not MI risk (HR: 1.39; low certainty).

Conclusions:

  • In post-MI patients with LVEF >40% and no heart failure, beta-blocker discontinuation may not elevate mortality or MI risk.
  • A potential increase in MACE, primarily due to cardiovascular hospitalizations, is associated with beta-blocker discontinuation.
  • Low certainty of evidence highlights the need for cautious interpretation of these findings.
Abstract

Keywords:
beta-blockersdeprescribingmyocardial infarction

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