Overview
- An individual-patient meta-analysis pooling five contemporary randomized trials found no reduction in death, recurrent myocardial infarction, or heart failure when beta-blockers were started after MI in patients with left ventricular ejection fraction of at least 50%.
- The analysis, presented at the AHA Scientific Sessions and published in the New England Journal of Medicine, included REBOOT, REDUCE-AMI, BETAMI, DANBLOCK, and CAPITAL-RCT.
- Over a median 3.6 to nearly 4 years of follow-up, about 8% of participants experienced a major event in both groups, with a primary outcome hazard ratio of 0.97 and low between-trial heterogeneity.
- Results were consistent across prespecified subgroups, and a previously suggested adverse signal in women was not statistically significant in the pooled data.
- The trials excluded patients already taking beta-blockers for other indications, so the findings apply to initiating therapy after MI with preserved ejection fraction, and investigators urge patients not to stop current prescriptions without medical advice.