Beta-Blockers after MI without Reduced Ejection Fraction
Beta-Blockers after MI without Reduced Ejection Fraction
NEJM – August 30, 2025
1. Background
• Guidelines recommend beta-blockers after MI, but evidence comes from older trials (before modern reperfusion, stents, and contemporary drugs).
• Uncertainty remains for patients with preserved EF (>40%).
2. Methods
• Open-label, randomized trial in Spain & Italy.
• 8,438 patients with acute MI (STEMI & NSTEMI), EF >40%.
• Randomized to beta-blocker therapy vs. no beta-blocker.
• Primary outcome = composite of all-cause death, reinfarction, or HF hospitalization.
• Median follow-up: 3.7 years.
3. Results
• Primary outcome: No difference (HR 1.04; CI 0.89–1.22; P=0.63).
• Death: 11.2 vs. 10.5 events/1000 pt-yrs (HR 1.06).
• Reinfarction: 10.2 vs. 10.1 events/1000 pt-yrs (HR 1.01).
• HF hospitalization: 2.7 vs. 3.0 events/1000 pt-yrs (HR 0.89).
• Safety: No major differences.
4. Conclusion
• In post-MI patients with EF >40% receiving modern invasive & pharmacologic care, beta-blockers did not reduce mortality, reinfarction, or HF hospitalization.
• Suggests limited benefit for routine use in this subgroup.
