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β-Blockers Not Beneficial After MI Without Reduced Left Ventricular Ejection Fraction

By Elana Gotkine HealthDay Reporter

Posted on September 2025

Medically reviewed by Carmen Pope, BPharm. Last updated on Sep 2, 2025.

TUESDAY, Sept. 2, 2025 -- For patients with acute myocardial infarction (MI), beta-blockers are not beneficial in those without reduced left ventricular ejection fraction (LVEF), but are beneficial for those with mildly reduced LVEF, according to two studies published online Aug. 30 in the New England Journal of Medicine and The Lancet to coincide with the European Society of Cardiology Congress 2025, held from Aug. 29 to Sept. 1 in Madrid.

Borja Ibanez, M.D., Ph.D., from the Centro Nacional de Investigaciones Cardiovasculares Carlos III in Madrid, and colleagues conducted an open-label randomized trial to assess the effect of beta-blocker therapy in patients with acute MI and LVEF >40 percent. A total of 4,243 and 4,262 patients were randomly assigned to receive beta-blocker and no beta-blocker therapy, respectively. The researchers found that a primary outcome event (composite of death from any cause, reinfarction, or hospitalization for heart failure) occurred in 316 and 307 patients in the beta-blocker and no beta-blocker groups (22.5 versus 21.7 events per 1,000 patient-years; hazard ratio, 1.04; 95 percent confidence interval, 0.89 to 1.22; P = 0.63) during a median follow-up of 3.7 years.

Xavier Rossello, M.D., Ph.D., also from the Centro Nacional de Investigaciones Cardiovasculares Carlos III, and colleagues conducted an individual patient-level meta-analysis of patients who recently had an MI and had mildly reduced LVEF (LVEF 40 to 49 percent) and no history or signs of heart failure from four clinical trials. The meta-analysis included 1,885 patients: 991 were assigned to beta-blockers and 894 were assigned to control (no beta-blockers). The researchers found that the primary composite end point (all-cause death, new MI, or heart failure) occurred in 106 and 129 patients in the beta-blocker and no beta-blocker groups, respectively (32.6 versus 43.0 events per 1,000 patient-years, respectively; hazard ratio, 0.75; 95 percent confidence interval, 0.58 to 0.97; P = 0.031).

"These findings will form the basis for future treatment of myocardial infarction and will drive a major shift in clinical practice guidelines," Ibanez said in a statement. "The trial was designed to optimize heart attack care based on solid scientific evidence and without commercial bias. These results will help simplify and streamline treatment, reduce adverse effects, and improve the quality of life for thousands of patients every year."

Several authors from the Ibanez study and one from the Rossello study disclosed ties to the biopharmaceutical industry.

Abstract/Full Text - Ibanez (subscription or payment may be required)

Abstract/Full Text - Rossello (subscription or payment may be required)

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Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.

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