BACKGROUND: The benefit of beta-blockers after myocardial infarction in patients with a preserved left ventricular ejection fraction (LVEF) is unclear.

METHODS: We conducted a meta-analysis at the individual-patient level using data from five open-label trials that randomly assigned patients with recent myocardial infarction, no other indications for beta-blocker therapy, and an LVEF of at least 50% to receive beta-blocker therapy or no beta-blocker therapy. The primary end point was a composite of death from any cause, myocardial infarction, or heart failure. Event rates were analyzed with a one-stage fixed-effects Cox proportional-hazards model.

RESULTS: A total of 17,801 patients were included from the REBOOT (7459 patients), REDUCE-AMI (4967 patients), BETAMI (2441 patients), DANBLOCK (2277 patients), and CAPITAL-RCT (657 patients) trials. Of these 17,801 patients, 8831 (49.6%) were assigned to receive a beta-blocker and 8970 (50.4%) were assigned to receive no beta-blocker. During a median follow-up of 3.6 years (interquartile range, 2.3 to 4.6), a primary-end-point event occurred in 717 patients (8.1%) in the beta-blocker group and 748 patients (8.3%) in the no-beta-blocker group (hazard ratio, 0.97; 95% confidence interval [CI], 0.87 to 1.07; P = 0.54). Death from any cause occurred in 335 patients in the beta-blocker group and 326 patients in the no-beta-blocker group (hazard ratio, 1.04; 95% CI, 0.89 to 1.21); myocardial infarction occurred in 360 and 407 patients, respectively (hazard ratio, 0.89; 95% CI, 0.77 to 1.03); and heart failure occurred in 75 and 87 patients (hazard ratio, 0.87; 95% CI, 0.64 to 1.19).

CONCLUSIONS: In this meta-analysis including individual-patient data from five randomized trials, beta-blocker therapy did not reduce the incidence of death from any cause, myocardial infarction, or heart failure in patients with an LVEF of at least 50% after myocardial infarction without other indications for beta-blockers. (Funded by Centro Nacional de Investigaciones Cardiovasculares Carlos III and others; PROSPERO database number, CRD420251119176.).

Internal Medicine rater

We may be able to discontinue beta-blockers in patients with preserved EF post-MI.

Internal Medicine rater

As a practicing physician, I find the results of this study highly impactful. The evidence directly informs real-world clinical decision-making and has the potential to meaningfully change day-to-day practice. By clarifying the role of beta-blocker therapy in patients post-myocardial infarction who have preserved LVEF, these findings help refine treatment strategies, reduce unnecessary medication use, and support more individualized evidence-based patient care.