Beta Blockers to Improve Post-MI Outcomes in Patients Without HF

Do beta blockers improve post–myocardial infarction (MI) outcomes in patients without heart failure (HF)?

Given the mixed evidence without a clear answer about the role of beta blockers in patients post-MI without HF, clinical teams should continue to follow local practice recommendations. (Strength of Recommendation: B, heterogeneous results of randomized controlled trials and meta-analyses of cohort studies.) Recent high-quality randomized controlled trials have shown that beta blockers do not decrease the risk of a composite outcome of death, nonfatal MI, nonfatal stroke, or hospitalization for another cardiovascular reason. However, other recent studies have shown that beta blockers reduce the risk of a composite outcome of death and major adverse cardiovascular events. Previous systematic reviews of mostly cohort studies inconsistently suggest benefits of using beta blockers post-MI.

A 2025 multicenter, randomized trial (N = 8,438) conducted in Spain and Italy examined the effects of beta-blocker therapy in patients with MI who received coronary angiography. Randomization occurred at hospital discharge or within 14 days of discharge; patients were assigned 1: 1 to a beta blocker or no beta blocker. The mean patient age was 61 years; 19% of participants were women, 45% reported cigarette use, 10% had a previous MI, and 12% were taking a beta blocker before hospitalization. The primary outcome was a composite of death from any cause, reinfarction, or hospitalization for HF. Subcomponents of each primary composite outcome (ie, death from cardiac causes, sustained ventricular tachycardia, ventricular fibrillation, resuscitated cardiac arrest) were secondary outcomes.¹

At a median follow-up of 3.7 years, the primary composite outcome occurred in 316 patients in the beta-blocker group and 307 patients in the no–beta-blocker group (22.5 vs 21.7 events per 1,000 patient-years; P = .63). There were no significant differences in the numbers of secondary outcomes between the beta-blocker and no–beta-blocker groups, including death from any cause (161 vs 153), reinfarction (143 vs 143), and death from cardiac causes (65 vs 57).¹

A 2025 multicenter, randomized trial (N = 5,574) performed in Denmark and Norway examined the effects of beta-blocker initiation within 14 days of MI. Patients were randomized 1: 1 to a beta blocker or no beta blocker. The median patient age was 63 years; 21% were women, 95% underwent a revascularization procedure, and 8% were taking a beta blocker before enrollment. The primary outcome was a composite of death from any cause or major adverse cardiovascular events.²

After a median follow-up of 3.5 years, the primary outcome occurred in 394 patients (14.2%) in the beta-blocker group and 454 patients (16.3%) in the no–beta-blocker group (hazard ratio = 0.85; 95% CI, 0.75–0.98; P = .03). When comparing the beta-blocker group with the no–beta-blocker group, there were no significant differences in the secondary outcomes of death from any cause (118 [4.2%] vs 124 [4.4%]) and unplanned coronary revascularization (108 [3.9%] vs 110 [3.9%]). A significant reduction in MI was noted in both groups (138 [5.0%] in the beta-blocker group vs 186 [6.7%] in the no–beta-blocker group; hazard ratio = 0.73; 95% CI, 0.59–0.92).²