In the contemporary reperfusion era, uncertainty remains regarding the long-term benefit of beta-blockers after MI in patients with preserved left ventricular ejection fraction (LVEF). Prior studies reported mortality benefits; however, the effect may have changed with modern therapies. A meta-analysis of RCTs published in the American Journal of Cardiovascular Drugs compared beta-blockers with no beta-blockers in this population.

Studies through October 2025 were identified in PubMed, Scopus, Web of Science, and Cochrane CENTRAL. Primary outcomes included recurrent myocardial infarction (MI), all-cause mortality, and heart failure (HF). Kaplan–Meier curves were used to reconstruct individual patient data for time-to-event analysis. Random-effects models estimated pooled risk ratios and hazard ratios. Meta-regression, trial sequential analysis (TSA), and GRADE certainty assessments were performed.

Five RCTs involving 23,524 patients met inclusion criteria. Beta-blockers did not significantly reduce recurrent acute myocardial infarction (AMI) (HR 0.89; 95% CI 0.78–1.02; P = 0.10), or HF (HR 0.92; 95% CI 0.71–1.20; P = 0.54). Secondary endpoints, including cardiovascular death, MACE, revascularization, and stroke, were also neutral (P > 0.05 across endpoints). Meta-regression identified no significant effect modifiers, and TSA boundaries were not crossed. The certainty of evidence was rated as low to moderate.

These findings suggest no reduction in ischemic events, HF events, or mortality with beta-blockers in patients with MI and preserved LVEF. Routine long-term beta-blocker use offers no prognostic advantage and should be reserved for specific indications such as reduced LVEF, angina, arrhythmia, or hypertension