Beta-blocker therapy after myocardial infarction in patients with preserved ejection fraction
An individual patient data meta-analysis evaluates the use of beta-blockers after myocardial infarction in individuals with left ventricular ejection fraction ≥50%.
Medical Affairs
3 min read
November 13, 2025
Beta-blocker therapy has long been considered the standard of care following acute myocardial infarction (MI). However, its role in patients with preserved ejection fraction (LVEF ≥50%) and without heart failure remains uncertain in modern practice, where most patients undergo early reperfusion and receive optimized medical therapy.
The individual patient data meta-analysis presented at AHA® 2025 combined five randomized trials (REBOOT, REDUCE-AMI, BETAMI, DANBLOCK, and CAPITAL-RCT) encompassing a total of 17,482 patients with MI and LVEF ≥50%. Of these, 49.8% received beta-blockers and 50.2% remained on standard therapy within 14 days after the index event. The population included 20.8% women, 44.6% with ST-elevation MI, and 93.4% treated with percutaneous coronary intervention (PCI). The most commonly used agents were bisoprolol (49.1%), metoprolol (46.8%), and carvedilol (4.8%).
After a median follow-up of more than three years, the primary composite endpoint, all-cause mortality, new MI, or heart failure, occurred in 8.3% of patients, with no significant difference between the beta-blocker and control groups. Similarly, there were no differences in secondary outcomes, including cardiovascular death, reinfarction, hospitalization for heart failure, ventricular arrhythmias, or stroke.
These findings indicate that in patients with MI and preserved ejection fraction, routine beta-blocker use does not reduce major clinical events, suggesting that this therapy may be best reserved for specific subgroups or for symptomatic management rather than routine post-MI use.
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References:
- Kristensen AMD, Rossello X, Atar D, et al. Beta-Blocker Therapy After Myocardial Infarction in Patients with Preserved Left Ventricular Ejection Fraction: An Individual Patient Data Meta-Analysis of Randomized Controlled Trials. Presented at the AHA Scientific Sessions 2025.
