Poster 030: Long-Term Beta Blockers in Post-Myocardial Infarction Patients with Preserved Ejection Fraction: An Updated Meta-Analysis of 74,907 Patients

Background: While beta-blockers (BBs) are well established in post-myocardial infarction (MI) care, their long-term role in patients with preserved ejection fraction (EF ≥50%) remains unclear. Previous studies have yielded conflicting results. We conducted an updated meta-analysis to assess the long-term efficacy of BBs on mortality and cardiovascular outcomes in this population.

Methods: Following PRISMA guidelines, A systematic search was conducted through August 2025 for RCTs and observational studies evaluating BB use in post-MI patients with preserved EF. Primary outcomes included all-cause mortality. Random-effects models were used; subgroup and sensitivity analyses were performed.

Outcome: Fifteen studies (3 RCTs, 12 observational), including 74,907 patients (mean EF 53.1%, mean age 63.8 years), were analyzed. BBs were associated with significantly reduced all-cause mortality at 1 year (RR 0.76; 95% CI: 0.69–0.83), 2 years (RR 0.78; 95% CI: 0.68–0.89), and 3 years (RR 0.82; 95% CI: 0.78–0.88). These effects were primarily observed in observational studies. RCTs showed no significant mortality benefit at any time point. Cardiovascular mortality was not significantly reduced overall (RR 0.75; 95% CI: 0.54-1.04; P=0.08); however, observational studies showed benefit (RR 0.60; P=0.02). No significant differences were found in MACE, MI, stroke, or heart failure hospitalization.

Conclusion: Beta-blockers are associated with reduced all-cause mortality in post-MI patients with preserved EF, driven mainly by observational data. No significant benefits were observed in cardiovascular mortality, recurrent MI, MACE, or other secondary outcomes.