Beta-Blockers in Patients with Normal Ejection Fraction after a Heart Attack

A meta-analysis was conducted using individual-patient data from five open-label randomized trials—REBOOT (7,459 patients), REDUCE-AMI (4,967), BETAMI (2,441), DANBLOCK (2,277), and CAPITAL-RCT (657). 

Patients with recent MI and no other indication for beta-blockers were assigned to receive either beta-blocker therapy or no beta-blocker therapy. The primary endpoint was a composite of death from any cause, recurrent MI, or heart failure, and event rates were analyzed using a one-stage fixed-effects Cox proportional-hazards model.

Among 17,801 patients, 8,831 (49.6%) received beta-blockers, and 8,970 (50.4%) did not. Over a median follow-up of 3.6 years (IQR, 2.3–4.6), primary-endpoint events occurred in 717 patients (8.1%) in the beta-blocker group and 748 patients (8.3%) in the no-beta-blocker group (hazard ratio [HR], 0.97; 95% CI, 0.87–1.07; P=0.54). Death from any cause occurred in 335 and 326 patients, respectively (HR, 1.04; 95% CI, 0.89–1.21); MI occurred in 360 and 407 patients (HR, 0.89; 95% CI, 0.77–1.03); and heart failure occurred in 75 and 87 patients (HR, 0.87; 95% CI, 0.64–1.19).

In patients with preserved LVEF after MI and no other indication for beta-blockers, beta-blocker therapy did not reduce the risk of death, recurrent MI, or heart failure. These findings were published in The New England Journal of Medicine.

References:

1. Kristensen AMD, Rossello X, Atar D, Yndigegn T, Kimura T, Latini R, Lindahl B, et al. Beta‑blockers after myocardial infarction with normal ejection fraction. N Engl J Med. 2025;383(19):1721‑1731. doi:10.1056/NEJMoa2512686.; https://www.nejm.org/doi/full/10.1056/NEJMoa2512686