Discontinuing beta-blockers increased adverse clinical risks after acute coronary syndrome (ACS) in patients with preserved LVEF. The meta-analysis included six studies with 144,661 ACS patients. Four studies discontinued beta-blockers at 12 months, and two discontinued at 11 and 6 months. The pooled analysis compared discontinuation with continuation using random-effects models for risk ratios (RR) and hazard ratios (HR). The outcomes included all-cause mortality (ACM), MACE, cardiovascular death, non-cardiovascular death, myocardial infarction, stroke, and unplanned revascularization.

Cardiovascular death increased with beta-blocker discontinuation (RR 1.30; 95% CI 1.14–1.48; p < 0.01). Non-cardiovascular death increased (RR 1.16; 95% CI 1.07–1.25; p < 0.01). Myocardial infarction increased (RR 1.11; 95% CI 1.03–1.19; p < 0.01). When analyses accounted for time-to-event data, no differences appeared for ACM (HR 1.02; 95% CI 0.95–1.10; p = 0.54) or MACE (HR 1.04; 95% CI 0.92–1.18; p = 0.53). No differences appeared for stroke (HR 1.02; 95% CI 0.89–1.17; p = 0.74) or unplanned revascularization (RR 0.95; 95% CI 0.86–1.06; p = 0.74).

These results indicate that discontinuing beta-blockers after ACS in the preserved LVEF population increases the risk of cardiovascular and non-cardiovascular death and increases myocardial infarction without affecting all-cause mortality or MACE. Further work is needed to identify subgroups that benefit most from continued long-term therapy.