ESC®️ 2025 – Beta-blockers after infarction in slightly reduced ejection fraction

Presented at ESC 2025, a meta-analysis of individual data brought together the main contemporary studies (REBOOT, BETAMI, DANBLOCK, and CAPITAL-RCT) to evaluate the impact of beta-blocker therapy after acute myocardial infarction in patients with mildly reduced ejection fraction (40–49%), no signs or history of heart failure. A total

of 1,885 patients were included, of whom 991 received beta-blockers and 894 were allocated to the control group.

During a median follow-up of more than one year, the primary endpoint—consisting of all-cause death, new infarction, or heart failure —occurred in 106 patients in the beta-blocker group versus 129 in the control group, corresponding to a rate of 32.6 versus 43.0 events per 1000 patient-years. The use of beta-blockers was associated with a 25% reduction in the relative risk of the composite endpoint (HR 0.75; 95%CI 0.58–0.97; p=0.031), with no significant heterogeneity between trials or participating countries.

These findings reinforce that beta-blocker therapy continues to be beneficial also in patients with only slightly reduced ejection fraction, expanding the evidence that already supported its indication in individuals with ejection fraction <40%.

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References:

1- Rossello X, Prescott EIB, Kristensen AMD, et al. β blockers after myocardial infarction with mildly reduced ejection fraction: an individual patient data meta-analysis of randomised controlled trials. Lancet. 2025; Online first Aug 30. doi:10.1016/S0140-6736(25)01592-2.