A Alnemer Khalid
Department of Internal Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia.
J Clin Med. 2025 Jun 4;14(11):3969. doi: 10.3390/jcm14113969.
Previous research has established that beta-blockers significantly reduce all-cause mortality, cardiovascular mortality, and recurrent acute myocardial infarction (AMI) in patients with left ventricular dysfunction following AMI. However, their efficacy in patients with preserved left ventricular ejection fraction (LVEF) who undergo timely reperfusion and revascularization while receiving evidence-based medical management remains inconclusive. To address this uncertainty, we conducted a systematic review and meta-analysis to synthesize the available evidence on the impact of beta-blocker therapy in patients with AMI and preserved LVEF. A comprehensive literature search was conducted across PubMed, the Web of Science, and Scopus from their inception until November 2024. The search strategy incorporated three primary keywords and their corresponding Medical Subject Headings (MeSH) terms: "preserved", "myocardial infarction", and "beta-blocker". Data analysis was performed using Review Manager 5.4 software. A random-effects model was applied to account for the study's heterogeneity, while a fixed-effects model was utilized for homogeneous outcomes. Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated for dichotomous outcomes, with a 95% confidence interval (CI) and a significance threshold of < 0.05. Beta-blocker therapy was significantly associated with a reduction in all-cause mortality compared to non-use, with an OR of 0.73 (95% CI: 0.61-0.88, = 0.001) and an HR of 0.78 (95% CI: 0.67-0.91, = 0.002). Similarly, beta-blocker administration was linked to a lower risk of cardiovascular mortality, demonstrating an OR of 0.76 (95% CI: 0.68-0.84, < 0.00001) and an HR of 0.76 (95% CI: 0.59-0.99, = 0.04). Furthermore, beta-blocker use was significantly correlated with a decreased risk of major adverse cardiovascular events (MACEs) compared to non-use, with an OR of 0.84 (95% CI: 0.75-0.95, = 0.004) and an HR of 0.84 (95% CI: 0.71-0.99, = 0.04). The current meta-analysis suggests a potential beneficial association between beta-blocker use and outcomes in patients with AMI and preserved LVEF, including lower rates of all-cause mortality, cardiovascular mortality, and MACEs; however, these findings should be interpreted with caution due to the observational nature of most included studies. Therefore, further randomized controlled trials (RCTs) are needed to confirm these findings, particularly in distinguishing outcomes among patients with and without heart failure.
以往的研究已证实，β受体阻滞剂可显著降低急性心肌梗死（AMI）后左心室功能不全患者的全因死亡率、心血管死亡率和复发性急性心肌梗死。然而，对于左心室射血分数（LVEF）保留且在接受循证医学管理的同时及时进行再灌注和血运重建的患者，β受体阻滞剂的疗效仍不明确。为解决这一不确定性，我们进行了一项系统评价和荟萃分析，以综合有关β受体阻滞剂治疗对AMI且LVEF保留患者影响的现有证据。从创刊至2024年11月，我们在PubMed、科学网和Scopus上进行了全面的文献检索。检索策略纳入了三个主要关键词及其相应的医学主题词（MeSH）：“保留”、“心肌梗死”和“β受体阻滞剂”。使用Review Manager 5.4软件进行数据分析。应用随机效应模型来考虑研究的异质性，而对于同质结果则使用固定效应模型。对于二分结局，计算合并比值比（OR）和风险比（HR），95%置信区间（CI）以及显著性阈值<0.05。与未使用β受体阻滞剂相比，β受体阻滞剂治疗与全因死亡率降低显著相关，OR为0.73（95%CI：0.61 - 0.88，P = 0.001），HR为0.78（95%CI：0.67 - 0.91，P = 0.002）。同样，β受体阻滞剂给药与心血管死亡率风险较低相关，OR为0.76（95%CI：0.68 - 0.84，P < 0.00001），HR为0.76（95%CI：0.59 - 0.99，P = 0.04）。此外，与未使用相比，使用β受体阻滞剂与主要不良心血管事件（MACE）风险降低显著相关，OR为0.84（95%CI：0.75 - 0.95，P = 0.004），HR为0.84（95%CI：0.71 - 0.99，P = 0.04）。当前的荟萃分析表明，在AMI且LVEF保留的患者中，使用β受体阻滞剂与结局之间可能存在有益关联，包括全因死亡率、心血管死亡率和MACE发生率较低；然而，由于大多数纳入研究的观察性性质，这些发现应谨慎解释。因此，需要进一步的随机对照试验（RCT）来证实这些发现，特别是在区分有无心力衰竭患者的结局方面。
