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Beta Blockers After Acute Myocardial Infarction Without Left Ventricular Systolic Dysfunction: A Meta-Analysis of Randomized Controlled Trials
Journal article   Peer reviewed

Beta Blockers After Acute Myocardial Infarction Without Left Ventricular Systolic Dysfunction: A Meta-Analysis of Randomized Controlled Trials

Hritvik Jain, Jyoti Jain, Kriti Soni, Siddharth P Agrawal, Marwan S Saad, J Dawn Abbott and Saraschandra Vallabhajosyula
Mayo Clinic proceedings
28 Mar 2026
DOI: https://doi.org/10.1016/j.mayocp.2026.02.003
PMID: 41902805

Abstract

The role of beta blockers as a therapeutic intervention for heart failure (HF) with left ventricular systolic dysfunction (LVSD) is well established. Most of the early randomized controlled trials (RCTs) that supported the role of beta blockers after acute myocardial infarction (AMI) were conducted in the pre-reperfusion era and primarily included patients with LVSD. This era predated the modern standard of care that includes routine reperfusion; culprit with or without nonculprit revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting; and potent pharmacotherapies, such as P2Y12 inhibitors and statins.1 This care paradigm has been associated with lower rates of subsequent HF and long-term mortality after AMI. Therefore, the role of long-term beta-blocker therapy in patients without LVSD is less understood. Two recent RCTs, REBOOT (beta blockers after myocardial infarction without reduced ejection fraction) and BETAMI-DANBLOCK (beta blockers after myocardial infarction in patients without heart failure), report conflicting results on mortality and major adverse cardiovascular events with beta-blocker therapy.1,2 In that context, this meta-analysis of the reperfusion era RCTs aimed to investigate the efficacy and safety of beta blockers after AMI in patients without LVSD.

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