TY - JOUR
T1 - Beta-blockers after myocardial infarction without reduced ejection fraction: A meta-analysis of kaplan-meier reconstructed individual patient data
AU - Awashra, Ameer
AU - Emara, Ahmed
AU - Amin, Ahmed Mazen
AU - Hageen, Ahmed W.
AU - Elgendy, Mohamed S.
AU - Rakab, Mohamed Saad
AU - Hamzah, Khadeeja Ali
AU - Albukhari, Abdullah Faisal
AU - Nazir, Abubakar
AU - Shubietah, Abdalhakim
AU - Rmilah, Anan Abu
AU - Ruzieh, Mohammed
PY - 2026/2/19
Y1 - 2026/2/19
N2 - Background: The long-term benefit of beta-blockers (β-blockers) after myocardial infarction (MI) in patients with preserved left-ventricular ejection fraction (LVEF ≥ 40%) remains uncertain in the modern reperfusion era. Earlier trials showed mortality benefits, but contemporary therapies may have altered their effect.
Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) comparing β-blockers versus no β-blockers in adults with MI and LVEF ≥ 40%. PubMed, Scopus, Web of Science, and Cochrane CENTRAL were searched through October 2025. Primary outcomes were all-cause mortality, recurrent MI, and heart failure (HF). Individual patient data (IPD) were reconstructed from Kaplan-Meier curves for time-to-event analysis, and pooled risk ratios (RRs) and hazard ratios (HRs) were estimated using random-effects models. Trial sequential analysis (TSA), meta-regression, and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) certainty assessments were performed.
Results: Five RCTs (n = 23,524 patients) met inclusion criteria. β-Blockers did not significantly reduce recurrent acute myocardial infarction (AMI) (HR: 0.89 with 95% confidence interval [CI 0.78, 1.02], P = 0.1), HF (HR: 0.92 with 95% CI [0.71, 1.20], P = 0.54), and all-cause mortality (HR: 0.97 with 95% CI [0.85, 1.10], P = 0.63). Secondary endpoints-including major adverse cardiovascular events (MACE), cardiovascular death, stroke, and revascularization-were neutral (P > 0.05). TSA boundaries were not crossed, and meta-regression identified no significant effect modifiers. Evidence certainty was rated low to moderate.
Conclusions: Among patients with MI and preserved LVEF, β-blockers did not reduce mortality or ischemic or HF events. Routine long-term use offers no prognostic advantage and should be reserved for specific indications such as reduced LVEF, angina, arrhythmia, or hypertension.
AB - Background: The long-term benefit of beta-blockers (β-blockers) after myocardial infarction (MI) in patients with preserved left-ventricular ejection fraction (LVEF ≥ 40%) remains uncertain in the modern reperfusion era. Earlier trials showed mortality benefits, but contemporary therapies may have altered their effect.
Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) comparing β-blockers versus no β-blockers in adults with MI and LVEF ≥ 40%. PubMed, Scopus, Web of Science, and Cochrane CENTRAL were searched through October 2025. Primary outcomes were all-cause mortality, recurrent MI, and heart failure (HF). Individual patient data (IPD) were reconstructed from Kaplan-Meier curves for time-to-event analysis, and pooled risk ratios (RRs) and hazard ratios (HRs) were estimated using random-effects models. Trial sequential analysis (TSA), meta-regression, and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) certainty assessments were performed.
Results: Five RCTs (n = 23,524 patients) met inclusion criteria. β-Blockers did not significantly reduce recurrent acute myocardial infarction (AMI) (HR: 0.89 with 95% confidence interval [CI 0.78, 1.02], P = 0.1), HF (HR: 0.92 with 95% CI [0.71, 1.20], P = 0.54), and all-cause mortality (HR: 0.97 with 95% CI [0.85, 1.10], P = 0.63). Secondary endpoints-including major adverse cardiovascular events (MACE), cardiovascular death, stroke, and revascularization-were neutral (P > 0.05). TSA boundaries were not crossed, and meta-regression identified no significant effect modifiers. Evidence certainty was rated low to moderate.
Conclusions: Among patients with MI and preserved LVEF, β-blockers did not reduce mortality or ischemic or HF events. Routine long-term use offers no prognostic advantage and should be reserved for specific indications such as reduced LVEF, angina, arrhythmia, or hypertension.
U2 - 10.1007/s40256-026-00789-6
DO - 10.1007/s40256-026-00789-6
M3 - Article
JO - American journal of cardiovascular drugs : drugs, devices, and other interventions
JF - American journal of cardiovascular drugs : drugs, devices, and other interventions
ER -