TOPLINE:

A meta-analysis of four randomized trials found no significant long-term reduction in the risk for mortality or other cardiovascular outcomes with beta-blockers in patients with preserved left ventricular ejection fraction (LVEF) after myocardial infarction (MI).

METHODOLOGY:

• Although beta-blockers have been routinely used after MI for reduced LVEF, recent trials have shown mixed results in patients with preserved LVEF (≥ 50%). This leaves uncertainty about their cardiovascular advantage, or which subgroups (if any) might benefit.
• Researchers conducted a meta-analysis to determine whether beta-blockers improved long-term cardiovascular outcomes after MI in patients with preserved LVEF by using trial searches up to August 30, 2025.
• They included four randomized clinical trials with patients post-MI. Three trials enrolled patients with LVEF > 40%, and one had patients with LVEF > 50%. Subgroup data were extracted to focus on those with LVEF ≥ 50%.
• The pooled dataset comprised 19,826 patients (mean age, 61.3-65 years; 77.5%-80.7% men). A total of 8901 patients had been randomly assigned to receive beta-blockers.
• Over a median follow-up duration of 3.5-5.0 years, researchers compared the risk for all-cause mortality, cardiovascular mortality, MI, heart failure, and unplanned revascularization between users and nonusers of beta-blockers.

TAKEAWAY:

• A total of 338 deaths (3.80%) occurred among users of beta-blockers. The risk for all-cause mortality did not differ between users and nonusers of beta-blockers (relative risk, 1.02; 95% CI, 0.88-1.19).
• Researchers found no significant differences between the two groups in terms of the risk for cardiovascular mortality, MI, heart failure, or unplanned revascularization.
• The heterogeneity between studies was negligible for most outcomes (I² = 0.0%). The highest reported I² was 16.6% for MI.
• Metoprolol and bisoprolol were the most used beta-blockers; one trial used carvedilol.

IN PRACTICE:

“Advances in contemporary MI management, including early revascularization and optimal medical therapy, have contributed to improved outcomes in patients after MI. Accordingly, the benefit derived from traditional therapies may be attenuated in some populations. The absence of significant benefit from beta-blockers in patients with preserved LVEF may reflect a ceiling effect imposed by optimized background therapy,” the researchers wrote.

SOURCE:

This study was led by Linjie Li, MD, of Tianjin Medical University General Hospital in Tianjin, China. It was published online on January 07, 2026, in JAMA Cardiology.

LIMITATIONS:

The meta-analysis used published aggregate data instead of individual patient data. Only a few trials met inclusion, which limited statistical power. Some trials did not target patients with LVEF ≥ 50%, which created possible selection bias.

DISCLOSURES:

This study received grants from the National Natural Science Foundation of China and Singapore National Medical Research Council. The authors did not report any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.