Use of beta-blockers has been a cornerstone in the treatment era following acute myocardial infarction (MI), especially in the presence of low left ventricular ejection fraction (LVEF≤40%). Yet new data have emerged suggesting a lack of benefit in the primary endpoint for beta-blocker use among patients post-MI. This meta-analysis reveals no reduction in the primary endpoint in those taking beta-blockers in the setting of preserved LVEF (LVEF ≥ 50%). The study was published in JAMA Cardiology by Linjie Li and colleagues.
The purpose of this meta-analysis was to examine the relationship of β-blockers with CV events following acute MI, in particular in patients with a preserved LVEF of at least 50%. The meta-analysis was performed based on PRISMA guidelines and considered RTCs published as of August 30, 2025. The meta-analysis evaluated four trials, namely CAPITAL-RCT, REDUCE-AMI, REBOOT-CNIC, and BETAMI-DANBLOCK trials.
A total of 19,826 patients took part in the meta-analysis, with a follow-up period of 3.5-5.0 years. The endpoints of this meta-analysis included all-cause mortality, CV mortality, myocardial infarction, heart failure, and unplanned revascularization. The end result of this meta-analysis was gauged through the calculation of the RR with 95% CI using the Mantel-Haenszel model.
Key findings
Among 19,826 patients with preserved LVEF followed for up to 5 years, β-blocker therapy was not associated with reductions in all-cause mortality, cardiovascular mortality, myocardial infarction, heart failure, or unplanned revascularization.
Overall mortality was 3.80% in the β-blocker group, with no significant difference compared with controls.
During follow-up, 338 deaths (3.80%) occurred among 8,901 patients treated with β-blockers.
There was no significant difference in all-cause mortality between patients receiving β-blockers and those in the control groups (RR, 1.02; 95% CI, 0.88–1.19).
Similarly, cardiovascular mortality did not differ significantly between groups (RR, 1.25; 95% CI, 0.94–1.68), indicating no survival advantage with β-blocker therapy in patients with preserved LVEF.
The risk of recurrent myocardial infarction was similar between groups (RR, 0.89; 95% CI, 0.78–1.03).
There were also no significant differences in heart failure events (RR, 0.87; 95% CI, 0.64–1.18) or unplanned revascularization (RR, 1.04; 95% CI, 0.87–1.23).
Findings indicate that in patients with acute myocardial infarction (MI) and preserved left ventricular ejection fraction (≥50%), β-blocker therapy is not associated with improvement in major cardiovascular outcomes. Further large-scale, targeted studies are required to define optimal pharmacologic management and to identify subgroups that may still benefit from β-blocker use.
Reference:
Li L, Li J, Jiang S, et al. β-Blockers After Myocardial Infarction in Patients With Preserved Ejection Fraction: A Meta-Analysis. JAMA Cardiol. Published online January 07, 2026. doi:10.1001/jamacardio.2025.4923
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