- Question
- Is beta-blocker therapy still beneficial after acute myocardial infarction when ejection fraction is not reduced, in the current era of reperfusion, complete revascularization and modern pharmacologic therapy?
- Design
- Pragmatic, randomized, open-label, phase 4 trial conducted in Spain and Italy. A total of 8505 patients were randomized (4243 to beta-blocker and 4262 to no beta-blocker); after exclusions, 8438 were included in the main analysis. Median follow-up was 3.7 years.
- Population
- Patients discharged after acute myocardial infarction, with or without ST-segment elevation, managed with an invasive strategy and with a left ventricular ejection fraction above 40%.
- Intervention
- Beta-blocker therapy (atenolol, bisoprolol, carvedilol, metoprolol or nebivolol), with agent and dose left to the treating physician.
- Control
- No beta-blocker therapy.
- Primary outcome
- Composite of death from any cause, reinfarction, or hospitalization for heart failure.
- Results
- A primary-outcome event occurred in 316 patients (22.5 events per 1000 patient-years) with beta-blocker and in 307 (21.7 per 1000 patient-years) without (HR 1.04; 95% CI 0.89 to 1.22; P = 0.63). Death from any cause was similar between groups (HR 1.06; 95% CI 0.85 to 1.33).
- Safety
- No apparent between-group differences were noted in safety outcomes.
- Conclusion
- Among patients discharged after invasive care for myocardial infarction with ejection fraction above 40%, beta-blocker therapy showed no effect on death, reinfarction or heart failure hospitalization.
- Why it matters
- It challenges the routine long-term use of beta-blockers in this patient profile, since earlier evidence came from the era before reperfusion and current therapies.
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 18, 2026