What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Myocardial infarction with LVEF >40% (n=19826). Intervention: Beta-blockers vs. No beta-blockers. Primary outcome: All-cause mortality (HR 0.98, 95% CI 0.85-1.13).

February 28, 2026

Beta-Blockers in Patients with Myocardial Infarction and No Heart Failure: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Key Result

Beta-blocker therapy in patients with myocardial infarction and LVEF >40% did not significantly reduce all-cause mortality compared to no beta-blockers (HR 0.98; 95% CI 0.85-1.13).

Key Points

Evaluate the efficacy of beta-blockers in patients with myocardial infarction and preserved left ventricular ejection fraction.
Conducted a systematic review and meta-analysis of randomized clinical trials published after 2000.
Search included databases: PubMed, Embase, and CENTRAL.
Estimated hazard ratios and risk ratios using RevMan web.
No significant reduction in all-cause mortality (HR 0.98, 95% CI 0.85-1.13) or cardiac mortality (HR 1.16, 95% CI 0.89-1.51).
Trend toward lower myocardial infarction incidence (HR 0.88, 95% CI 0.77-1.00) and new onset heart failure (HR 0.82, 95% CI 0.63-1.07).
No significant increase in symptomatic AV block (HR 1.06, 95% CI 0.83-1.34) or stroke (RR 1.16, 95% CI 0.9-1.48).

Study Design

Type

Meta-Analysis (n=19,826)

Structured PICO

Does beta-blocker therapy reduce mortality and cardiovascular events in patients with myocardial infarction and LVEF >40%?

Population

19,826 patients from 5 RCTs with myocardial infarction (MI) and left ventricular ejection fraction (LVEF) >40%

Intervention

Beta-blockers as a class

Comparator

No beta-blockers

Outcome

All-cause mortalityhard clinical

In patients with myocardial infarction and preserved ejection fraction (LVEF >40%), routine beta-blocker therapy does not significantly reduce all-cause mortality or other major cardiovascular outcomes.

Main Result

Effect estimate: HR 0.98 (95% CI 0.85-1.13)

Abstract

BACKGROUND β-blockers have an established role in patients with myocardial infarction (MI) and left ventricular ejection fraction (LVEF) 40%, emerging new trials have inconsistent results. We conducted a meta-analysis to evaluate the outcomes of β-blocker therapy compared no β-blocker therapy in patients with MI and LVEF >40% METHODS: We searched PubMed, Embase, and CENTRAL for randomized clinical trials (RCTs) published after 2000. Meta-analyses estimated hazard ratio (HR) or risk ratio (RR) with 95% confidence intervals (CI) using RevMan web. RESULTS Five RCTs (N = 19,826) met the inclusion criteria, with 9,892 patients (49.8%) were randomized to β-blockers and 9,934 (50.2%) to no β-blockers. All trials enrolled patients with MI and LVEF >40%. Meta-analysis demonstrated that β-blockers were not associated with significant reduction in all-cause mortality (HR 0.98, 95% CI 0.85-1.13), cardiac mortality (HR 1.16, 95% CI 0.89-1.51), unplanned coronary revascularization (HR 1.01, 95% CI 0.87-1.17), or malignant ventricular arrhythmia (RR 0.87, 95% CI 0.51-1.48). β-blockers were associated with a trend toward lower MI (HR 0.88, 95% CI 0.77-1.00) and new onset heart failure (HF) (HR 0.82, 95% CI 0.63-1.07). β-blockers were not associated with an increase in symptomatic AV block (HR 1.06, 95% CI 0.83-1.34), or stroke (RR 1.16, 95% CI 0.9-1.48). CONCLUSION In patients with MI with LVEF >40%, β-blockers were not associated with a significant effect on any outcome; β-blockers were associated with a trend toward lower MI and HF.

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