Large Meta-Analysis Questions Beta-Blocker Use After MI with Normal EF

For decades, beta-blockers have been a foundational therapy after myocardial infarction (MI). However, their benefit in patients who have a preserved left ventricular ejection fraction (LVEF ≥50%) in the modern PCI and statin era has remained uncertain. This large individual patient–level meta-analysis helps clarify the picture.

Drawing data from five randomized trials and nearly 18,000 post-MI patients without any other indication for beta-blockade, the analysis found no significant reduction in the composite outcome of all-cause mortality, recurrent MI, or heart failure over a median 3.6-year follow-up. Event rates were strikingly similar between those who received beta-blockers (8.1%) and those who did not (8.3%), with a hazard ratio of 0.97 (95% CI, 0.87–1.07). None of the individual components—death, MI, or heart failure—showed meaningful benefit either.

These findings underscore a growing consensus: in patients with preserved EF and no compelling indication, routine long-term beta-blocker therapy after MI offers no clear clinical advantage. Contemporary management must now shift toward selective, evidence-based use rather than tradition-driven prescribing.