- Question
- Is long-term beta-blocker therapy still beneficial after acute myocardial infarction when left ventricular ejection fraction is preserved, in the era of modern revascularization and medical therapy?
- Design
- Randomized, open-label, parallel-group trial conducted at 45 centers in Sweden, Estonia and New Zealand; 5020 patients were randomized (95.4% from Sweden), with a median follow-up of 3.5 years.
- Population
- Patients with acute myocardial infarction who underwent coronary angiography and had a left ventricular ejection fraction of at least 50%.
- Intervention
- Long-term treatment with a beta-blocker (metoprolol or bisoprolol), with dose at the treating physician's discretion.
- Control
- No beta-blocker treatment, with the remainder of evidence-based care.
- Primary outcome
- Composite of death from any cause or new myocardial infarction.
- Results
- The primary event occurred in 199 of 2508 patients (7.9%) with a beta-blocker and in 208 of 2512 (8.3%) without (HR 0.96; 95% CI 0.79 to 1.16; P = 0.64). All-cause death was 3.9% and 4.1%, respectively.
- Safety
- Hospitalization for bradycardia, second- or third-degree atrioventricular block, hypotension, syncope or pacemaker implantation occurred in 3.4% with a beta-blocker and 3.2% without; hospitalization for asthma or COPD was 0.6% in both groups.
- Conclusion
- In patients with acute myocardial infarction and preserved ejection fraction, long-term beta-blocker treatment did not reduce the risk of death or new myocardial infarction compared with no beta-blocker.
- Why it matters
- It challenged the routine long-term use of beta-blockers in patients with myocardial infarction and preserved ventricular function, supporting a reassessment of this practice in the context of contemporary treatment.
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 7, 2026