Impact of beta-blockers on cardiovascular outcomes in myocardial infarction patients with preserved or mildly reduced ejection fraction: systematic review and meta-analysis of randomized trials

Neira-Chunga L.D.; Moncada-Gutiérrez D.A.; Vásquez-Tirado G.A.; Morales-Piscoya M.I.; Guzmán-Aguilar W.M.; Quispe-Castañeda C.V.; Meregildo-Rodríguez E.D.; Farfán-Castillo A.; Serna-Alarcón V.; Ortiz-Pizarro M.; Villarreal-Jara M. · Medicina Intensiva (2026) · DOI: 10.1016/j.medin.2026.502544

Resumen

Objective To evaluate the association between beta-blocker therapy and major cardiovascular outcomes in patients with acute myocardial infarction (AMI) and preserved or mildly reduced left ventricular ejection fraction (LVEF). Design Systematic review and meta-analysis of randomized clinical trials. Setting A comprehensive search of five electronic databases was conducted using a predefined PICO strategy to identify published studies. Seven studies were selected and included in the meta-analysis. Participants Patients with AMI and preserved or mildly reduced LVEF who received beta-blocker therapy. Intervention Use of beta-blockers. Main outcome measures Primary composite outcome including mortality, reinfarction, cardiovascular-related hospitalization, and other cardiovascular events. Results This meta-analysis included four studies comprising a total of 18,504 patients with a history of AMI and an LVEF ≥ 40%. Among them, 2,223 patients had mildly reduced LVEF, while 15,908 belonged to the preserved LVEF group. Beta-blocker therapy did not reduce the primary composite outcome (death, reinfarction, and hospitalization) in patients with LVEF ≥ 40% (hazard ratio [HR]: 0.90; 95% confidence interval [95% C I]: 0.81-1.01). Subsequent subgroup analyses showed that beta-blocker therapy did not reduce the primary composite outcome in patients with preserved LVEF (HR: 0.94; 95% CI: 0.87-1.03); however, in patients with mildly reduced LVEF, it was associated with a reduction in the same primary composite outcome (HR: 0.82; 95% CI: 0.70-0.97). Conclusions In this meta-analysis, beta-blocker use was not associated with a significant reduction in the primary composite outcome or in mortality or reinfarction. The association observed in patients with mildly reduced ejection fraction derives from a subgroup and should be interpreted with caution in the context of an overall neutral result.

Instituciones: Universidad Peruana Cayetano Heredia; Universidad Privada Antenor Orrego; Universidad Católica Santo Toribio de Mogrovejo