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

β-blocker and clinical outcomes in patients after myocardial infarction: a systematic review and meta-analysisEur J Clin Pharmacol. 2025 Dec;81(12):1807-1817.AbstractBackground and objective: While current clinicalguidelines 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 acutemyocardial infarction populations.Methods: We conducted comprehensive searches ofthe 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 acute myocardial infarction patients. Our analysisstratified these effects by study type, ejection fraction (EF), sample size, follow-up duration, and patient characteristics including primary coronary revascularization, ST segmentelevation status, and comorbidities.Results: This meta-analysis incorporated 34 observational studies covering 233,303  acute myocardial infarction patients. Our results showed beta-blockers reducedall-cause (OR = 0.73, 95% CI = 0.64-0.82) and cardiac mortality (OR = 0.79, 95% CI = 0.70-0.89) in post- acute myocardial infarction patients, with no significant effect on major adversecardiac events. 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- acute myocardial infarction 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- acute myocardialinfarction patients with reduced ejection fraction and only decreased all-cause death in those with preserved ejection fraction.Conclusions: Our meta-analysis suggests beta-blockers may offer long-term clinical benefits to acute myocardialinfarction patients, particularly those with reduced ejection fraction. However, this is not conclusive for acute myocardial infarction patients with comorbidities or preserved ejection fraction.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.