CLINICAL QUESTION

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

EVIDENCE-BASED ANSWER

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.

EVIDENCE SUMMARY

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