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Efficacy of Beta-Blocker Therapy in Post-Myocardial Infarction Patients With Preserved or Mildly Reduced Ejection Fraction: A Systematic Review and Meta-Analysis
Session:
Sessão de Comunicações Orais 07 – Para além do evento agudo: preditores e desfechos após lesão miocárdica
Speaker:
Bernardo Lisboa Resende
Congress:
CPC 2026
Topic:
P. Other
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Bernardo Resende; Emídio Mata; Ana Marta Pinto; Tomás Carlos; Luísa Rocha; Miguel Vicente; Mafalda Griné; João Português; Sílvia Ribeiro; João Gameiro; António Lourenço; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt">Background:</span></strong><span style="font-size:11.0pt"> While beta-blockers are well established for secondary prevention after myocardial infarction (MI) in patients with reduced left ventricular ejection fraction (LVEF), their long-term benefit in the reperfusion era among those with preserved (pEF) or mildly reduced (mrEF) LVEF remains uncertain in the era of modern reperfusion and optimized medical therapy. This study aimed to evaluate the efficacy and prognostic relevance of beta-blockers in contemporary post-MI patients without left ventricular systolic dysfunction. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt">Methods:</span></strong><span style="font-size:11.0pt"> Following PRISMA guidelines, we conducted a systematic search of CENTRAL, PubMed, Scopus, and EMBASE identified randomized controlled trials (RCTs) comparing long-term beta-blocker therapy versus usual care in post-MI patients with LVEF ≥ 40%. Primary outcomes were all-cause mortality and recurrent MI; secondary outcomes included cardiovascular (CV) mortality, heart failure hospitalization (HFH), malignant ventricular arrhythmias, stroke, and unplanned revascularization. Random-effects meta-analyses were performed using inverse-variance weighting. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt">Results:</span></strong><span style="font-size:11.0pt"> Four multicenter RCTs (2017–2024) comprising 19,826 patients (mean follow-up 3.6 years) met inclusion criteria. Beta-blocker therapy did not significantly reduce all-cause mortality (HR 0.98, 95% CI 0.85–1.12; I² = 0%) or recurrent MI (HR 0.88, 95% CI 0.74–1.05; I² = 32%). No significant differences were observed for CV mortality (HR 1.15, 95% CI 0.88–1.52), HFH (HR 0.85, 95% CI 0.61–1.19), stroke (RR 1.13, 95% CI 0.77–1.65), or revascularization (HR 1.00, 95% CI 0.85–1.18). Sensitivity analyses confirmed robustness, and heterogeneity was low. The certainty of evidence was rated high for primary outcomes. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt">Conclusions:</span></strong><span style="font-size:11.0pt"> In the contemporary reperfusion era, long-term beta-blocker therapy after MI does not confer significant reductions in mortality or recurrent ischemic events among patients with preserved or mildly reduced LVEF. These findings support individualized, risk-based continuation strategies, reserving chronic beta-blockade for patients with residual ventricular dysfunction or other specific indications.</span></span></span></p>
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