Beta-blocker therapy after AMI demonstrated clinical benefit only in patients with mildly reduced LVEF, with no measurable advantage in preserved systolic function. These findings were reported in Cardiovascular Drugs and Therapy in a contemporary systematic review and meta-analysis of randomized controlled trials.

The analysis included 19,826 patients with preserved or mildly reduced LVEF and a minimum follow-up of 1 year. Beta-blockers were prescribed to 9,892 patients, while 9,934 patients received no beta-blocker therapy. All included trials reflected management in the modern reperfusion era. Risk ratios were calculated using a Mantel-Haenszel random-effects model, with prespecified subgroup analyses by LVEF category and sex.

In the pooled population, beta-blocker therapy did not reduce the primary composite outcome (risk ratio [RR] 0.93; 95% confidence interval [CI], 0.83–1.04). No significant differences were observed for all-cause death, reinfarction, or heart failure. Subgroup analysis showed no outcome reduction among patients with preserved LVEF (RR 0.96; 95% CI, 0.86-1.08).

In contrast, patients with mildly reduced LVEF demonstrated a significant reduction in the primary composite outcome (RR 0.76; 95% CI, 0.61-0.94). No significant interaction was observed by sex.

These results indicate that routine beta-blocker use after AMI provides no outcome benefit in preserved left ventricular systolic function, while supporting continued use in patients with mildly reduced LVEF.