Efficacy of Beta-Blockers in LVEF Greater Than or Equal To Fifty Percent Post-MI

Article Impact Level: HIGH
Data Quality: STRONG
Summary of New England Journal of Medicine https://doi.org/10.1056/NEJMoa2512686 
Dr. Anna Meta Dyrvig Kristensen  et al.

Points

This meta-analysis evaluated beta-blocker therapy after myocardial infarction in patients with preserved left ventricular ejection fraction.
Seventeen thousand eight hundred one patients from five randomized trials were included in the individual-patient level analysis.
Beta-blocker therapy did not significantly reduce the composite primary endpoint of death, myocardial infarction, or heart failure.
The hazard ratio for the primary endpoint was 0.97 (95% CI, 0.87 to 1.07), indicating no significant difference.
Individual outcomes, including death, myocardial infarction, and heart failure, also showed no significant reduction with beta-blockers.

Summary

This meta-analysis, leveraging individual-patient data from five open-label randomized trials, investigated the efficacy of beta-blocker therapy following myocardial infarction (MI) in patients with a preserved left ventricular ejection fraction (LVEF) of at least 50% and no other established indications for beta-blocker use. The study aggregated data from 17,801 patients across the REBOOT (7,459 patients), REDUCE-AMI (4,967 patients), BETAMI (2,441 patients), DANBLOCK (2,277 patients), and CAPITAL-RCT (657 patients) trials. Of these, 8,831 patients (49.6%) were assigned to receive a beta-blocker, while 8,970 patients (50.4%) were assigned to a no-beta-blocker regimen.

The primary endpoint was a composite of death from any cause, myocardial infarction, or heart failure, analyzed using a one-stage fixed-effects Cox proportional-hazards model. 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. The hazard ratio was 0.97 (95% confidence interval [CI], 0.87 to 1.07; P = 0.54), indicating no statistically significant difference between the two treatment arms.

Further analyses of individual components of the primary endpoint similarly yielded no significant benefits. 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). Heart failure occurred in 75 and 87 patients (hazard ratio, 0.87; 95% CI, 0.64 to 1.19). These findings collectively suggest that routine beta-blocker therapy after myocardial infarction, in the presence of preserved left ventricular ejection fraction and absence of other indications, does not reduce the incidence of major adverse cardiovascular events.

Link to the article: https://www.nejm.org/doi/10.1056/NEJMoa2512686

References

Kristensen, A. M. D., Rossello, X., Atar, D., Yndigegn, T., Kimura, T., Latini, R., Lindahl, B., Halvorsen, S., Olsen, M. H., Fuster, V., Hofmann, R., Vikenes, K., Maeng, M., Erlinge, D., Pocock, S., Karlström, P., Bakken, A., Lange, T., Barrabés, J. A., … Ibanez, B. (2025). Beta-blockers after myocardial infarction with normal ejection fraction. New England Journal of Medicine, NEJMoa2512686. https://doi.org/10.1056/NEJMoa2512686