Beta-Blockers no Longer Needed Post Myocardial Infarction in Patients without Heart Failure: A Meta-Analysis with GRADE Assessment

Abstract

Introduction. Beta-blockers are commonly prescribed after myocardial infarction; however, their benefit in patients without heart failure and with preserved left ventricular ejection fraction in the modern era of reperfusion therapy remains unclear. The aim of the study is to evaluate the effect of beta-blockers on clinical outcomes in patients without heart failure.Materials and methods. The authors conducted a systematic review and meta-analysis of randomized controlled trials evaluating beta-blocker therapy after discharge in patients with myocardial infarction without clinical manifestations of heart failure. Searches in PubMed, Scopus, Web of Science, and Cochrane CENTRAL were performed in February 2026. The primary outcome was major adverse cardiovascular and cerebrovascular events. Secondary outcomes included mortality, recurrent myocardial infarction, heart failure, revascularization, and stroke. Hazard ratios with 95% confidence intervals were pooled using a random-effects model.Results. Four randomized controlled trials including 19,826 patients were analyzed. Beta-blocker therapy was not associated with a significant reduction in the incidence of major adverse cardiovascular and cerebrovascular events (hazard ratio 0.98, 95% confidence interval: 0.91–1.06, p = 0.64) or any of the secondary outcomes: all-cause mortality (hazard ratio 0.98, 95% confidence interval: 0.85–1.13, p = 0.78), recurrent myocardial infarction (hazard ratio 0.88, 95% confidence interval: 0.72–1.07, p = 0.20), heart failure (hazard ratio 0.82, 95% confidence interval: 0.63–1.07, p = 0.14), revascularization (hazard ratio 1.01, 95% confidence interval: 0.87–1.17, p = 0.86), or stroke (hazard ratio 1.24, 95% confidence interval: 0.97–1.59, p = 0.09). Discussion and conclusion. In patients with acute myocardial infarction without heart failure and with preserved left ventricular function, routine beta-blocker therapy after discharge was not associated with a reduction in the incidence of major adverse cardiovascular and cerebrovascular events or their individual components in the context of contemporary reperfusion therapy. Further large-scale studies are required to develop individualized therapeutic approaches.