Beta-blocker therapy after myocardial infarction in the PCI Era: an updated meta-analysis

Introduction

Beta-blockers have long been recommended after myocardial infarction (MI) based on evidence from the pre- reperfusion era. However, in the contemporary era of routine percutaneous coronary

intervention (PCI) and guideline-directed medical therapy, the benefit of long-term beta-blocker use in patients with preserved or mildly reduced left ventricular ejection fraction (LVEF) remains uncertain. This meta- analysis evaluated whether beta-blocker therapy, compared with no therapy or treatment discontinuation, reduces major adverse cardiovascular events (MACE) in this population.

Methods

A systematic review and meta-analysis of randomized controlled and comparative trials published from January 2000 to October 2025 was conducted using major medical databases. Eligible studies enrolled adult post-MI patients with preserved or mildly reduced LVEF and compared beta-blocker therapy with no therapy or interruption. The primary outcome was all-cause mortality, with secondary outcomes including cardiovascular death, recurrent MI, heart failure hospitalization, and stroke. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models.

Results

Five randomized controlled trials—REBOOT CNIC, BETAMI, DANBLOCK, REDUCE-AMI, CAPITAL RCT, and the ABYSS trial—comprising a total of 23,524 patients were included in the analysis. Overall, participants were predominantly male, in their early to mid-60s, had preserved left ventricular ejection fraction, and underwent PCI with high use of contemporary guideline-directed medical therapy. Beta-blocker therapy was associated with a modest but statistically significant reduction in all-cause mortality (RR 0.92; 95% CI 0.85–0.99). However, no significant differences were observed in cardiovascular death, recurrent myocardial infarction, hospitalization for heart failure, or stroke. Heterogeneity across the evaluated outcomes was low.

Conclusion

In the contemporary PCI era, beta-blocker therapy after MI confers a small survival benefit but does not significantly reduce specific cardiovascular events in patients with preserved or mildly reduced LVEF, supporting an individualized approach to long-term therapy.