Prognostic impact of long-term beta-blockers post-stemi: a meta-analytic review

This meta-analysis assessed the long-term impact of beta-blocker therapy on all-cause mortality and cardiovascular outcomes in patients with ST-elevation myocardial infarction (STEMI) who continued beta-blocker use for a minimum of 1 year after hospital discharge.

Electronic databases were searched through September 2024 to identify studies comparing long-term outcomes in patients treated with beta-blockers versus those untreated. A random-effects model was used to estimate Hazard Ratios (HRs) with 95% confidence intervals (CIs).

A total of 21 studies involving 270 566 patients were included. In pooled analyses, extended beta-blocker was associated with significantly lower all-cause mortality in STEMI patients [HR: 0.74 (0.66, 0.83); P < 0.0001] and showing non-significant trend toward reducing cardiac death [HR: 0.77 (0.56, 1.04); P = 0.09], an effect observed predominantly in observational studies. However, in randomized controlled trials (N = 3), no significant benefit was demonstrated (all-cause mortality: P = 0.67; cardiac death: P = 0.62). No meaningful differences were found for major adverse cardiovascular events [HR: 0.90 (0.76, 1.07); P = 0.22], myocardial infarction, hospitalization for heart failure, or revascularization.

Long-term beta-blocker use is associated with a significant reduction in all-cause mortality among STEMI patients, though this benefit was not seen in RCTs. Effects on other cardiovascular outcomes remain uncertain, highlighting the need for further large-scale trials.