- Question
- In patients who have had a myocardial infarction and have a left ventricular ejection fraction of at least 40%, does long-term beta-blocker therapy reduce death and major cardiovascular events compared with no beta-blocker?
- Design
- Open-label, randomized trial with blinded end-point evaluation, conducted in Denmark and Norway. Patients were assigned 1:1 and 5574 were included in the main analyses; median follow-up was 3.5 years.
- Population
- Patients with myocardial infarction and a left ventricular ejection fraction of at least 40%, randomized within 14 days after the event.
- Intervention
- Long-term beta-blocker therapy started within 14 days after the infarction (2783 patients).
- Control
- No beta-blocker therapy (2791 patients); other care according to usual practice.
- Primary outcome
- Composite of death from any cause or major adverse cardiovascular events (new myocardial infarction, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmias).
- Results
- The primary end point occurred in 394 patients (14.2%) in the beta-blocker group and in 454 (16.3%) in the no-beta-blocker group (HR 0.85; 95% CI 0.75 to 0.98; P = 0.03). Among components, myocardial infarction was less frequent with beta-blocker (5.0% vs. 6.7%; HR 0.73; 95% CI 0.59 to 0.92), while all-cause death was similar (4.2% vs. 4.4%).
- Safety
- No apparent differences in safety outcomes were observed between the groups.
- Conclusion
- In patients with myocardial infarction and an ejection fraction of at least 40%, beta-blocker therapy lowered the risk of death or major adverse cardiovascular events compared with no beta-blocker therapy.
- Why it matters
- It provided contemporary evidence, in the era of modern reperfusion and current secondary prevention, on the role of beta-blockers after infarction without significant ventricular dysfunction, a setting where earlier evidence dated from a previous era.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026