Beta-Blockers after Myocardial Infarction with Normal Ejection Fraction
Anna Meta Dyrvig Kristensen, Xavier Rosselló, Dan Atar, Troels Yndigegn, Takeshi Kimura, Roberto Latini, Bertil Lindahl, Sigrun Halvorsen, Michael Hecht Olsen, Valentı́n Fuster, Robin Hofmann, Kjell Vikenes, Michael Mæng, David Erlinge, Stuart Pocock, Patric Karlström, Arnhild Bakken, Theis Lange, José A. Barrabés, Jocelyne Benatar, Sergio Raposeiras‐Roubín, Claes Held, Massimo Piepoli, Morten Wang Fagerland, Therese Lucia Friis Holmager, Neiko Ozasa, Eva Prescott, John Munkhaugen, Tomas Jernberg, Borja Ibáñez
Abstract
BACKGROUND: The benefit of beta-blockers after myocardial infarction in patients with a preserved left ventricular ejection fraction (LVEF) is unclear. METHODS: We conducted a meta-analysis at the individual-patient level using data from five open-label trials that randomly assigned patients with recent myocardial infarction, no other indications for beta-blocker therapy, and an LVEF of at least 50% to receive beta-blocker therapy or no beta-blocker therapy. The primary end point was a composite of death from any cause, myocardial infarction, or heart failure. Event rates were analyzed with a one-stage fixed-effects Cox proportional-hazards model. RESULTS: A total of 17,801 patients were included from the REBOOT (7459 patients), REDUCE-AMI (4967 patients), BETAMI (2441 patients), DANBLOCK (2277 patients), and CAPITAL-RCT (657 patients) trials. Of these 17,801 patients, 8831 (49.6%) were assigned to receive a beta-blocker and 8970 (50.4%) were assigned to receive no beta-blocker. During a median follow-up of 3.6 years (interquartile range, 2.3 to 4.6), a primary-end-point event occurred in 717 patients (8.1%) in the beta-blocker group and 748 patients (8.3%) in the no-beta-blocker group (hazard ratio, 0.97; 95% confidence interval [CI], 0.87 to 1.07; P = 0.54). Death from any cause occurred in 335 patients in the beta-blocker group and 326 patients in the no-beta-blocker group (hazard ratio, 1.04; 95% CI, 0.89 to 1.21); myocardial infarction occurred in 360 and 407 patients, respectively (hazard ratio, 0.89; 95% CI, 0.77 to 1.03); and heart failure occurred in 75 and 87 patients (hazard ratio, 0.87; 95% CI, 0.64 to 1.19). CONCLUSIONS: In this meta-analysis including individual-patient data from five randomized trials, beta-blocker therapy did not reduce the incidence of death from any cause, myocardial infarction, or heart failure in patients with an LVEF of at least 50% after myocardial infarction without other indications for beta-blockers. (Funded by Centro Nacional de Investigaciones Cardiovasculares Carlos III and others; PROSPERO database number, CRD420251119176.).