β-blocker and clinical outcomes in patients after myocardial infarction: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE

While current clinical guidelines generally advocate for beta-blocker therapy following acute myocardial infarction (AMI), conflicting findings have surfaced through large-scale observational studies and meta-analyses. We conducted this systematic review and meta-analysis of published observational studies to quantify the long-term therapeutic impact of beta-blocker across heterogeneous AMI populations.

METHODS

We conducted comprehensive searches of the PubMed, Embase, Cochrane, and Web of Science databases for articles published from 2000 to 2025 that examine the link between beta-blocker therapy and clinical outcomes (last search update: March 1, 2025). We used the odds ratio (OR) with its 95% confidence interval (95% CI) to evaluate the effect of beta-blocker therapy on all-cause mortality, cardiac death, or major adverse cardiac events (MACE) in AMI patients. Our analysis stratified these effects by study type, ejection fraction (EF), sample size, follow-up duration, and patient characteristics including primary coronary revascularization, ST-segment elevation status, and comorbidities.

RESULTS

This meta-analysis incorporated 34 observational studies covering 233,303 AMI patients. Our results showed beta-blockers reduced all-cause (OR = 0.73, 95% CI = 0.64-0.82) and cardiac mortality (OR = 0.79, 95% CI = 0.70-0.89) in post-AMI patients, with no significant effect on MACE. In these patients, post-PCI and STEMI patients, beta-blockers lowered all-cause mortality but not MACE risk. Subgroup analysis revealed that beta-blockers decreased all-cause death in post-AMI patients with diabetes and COPD, but not in those with hypertension and AF. Stratified by EF, beta-blockers were beneficial for all-cause death (OR = 0.75, 95% CI = 0.60-0.93), cardiac death (OR = 0.72, 95% CI = 0.56-0.92), and MACE (OR = 0.85, 95% CI = 0.76-0.96) in post-AMI patients with reduced EF and only decreased all-cause death in those with preserved EF.

CONCLUSIONS

Our meta-analysis suggests beta-blockers may offer long-term clinical benefits to AMI patients, particularly those with reduced EF. However, this is not conclusive for AMI patients with comorbidities or preserved EF.