Beta-Blocker Therapy After Myocardial Infarction in Patients with Preserved Left Ventricular Ejection Fraction: An Individual Patient Data Meta-Analysis of Randomized Controlled Trials
Abstract Body (Do not enter title and authors here): Background Beta-blocker therapy has been standard of care following myocardial infarction (MI), but in a contemporary setting, their role in MI patients without heart failure (HF) and with preserved left ventricular ejection fraction (LVEF≥50%) remains uncertain. To address this gap in knowledge, the totality of evidence derived from the five recent randomized controlled trials testing the effect of beta-blockers in patients with MI and LVEF≥50% will be pooled.
Methods This individual patient data (IPD) meta-analysis includes data from MI patients with LVEF≥50% enrolled in the REBOOT, REDUCE-AMI, BETAMI, DANBLOCK, and CAPITAL-RCT trials. All were open-label trials with a median follow-up >3 years. The main results are either published (REDUCE-AMI and CAPITAL-RCT) or will be published in late August 2025 (REBOOT, BETAMI, and DANBLOCK). To ensure all relevant trials were included, a systematic review of MEDLINE via PubMed was performed. The pre-specified primary endpoint is a composite of all-cause mortality, new MI, or HF. Key secondary endpoints include each component of the primary endpoint. Other endpoints include cardiac death, ventricular tachycardia/fibrillation, unplanned coronary revascularization, stroke, and advanced AV-block. A fixed-effect one-stage meta-analysis will be performed. An unadjusted Cox model stratified by trial will estimate the overall hazard ratio and its 95% confidence intervals. Cumulative time-to-first-event curves will be obtained through the Kaplan-Meier method and compared using the log-rank test. All analyses will follow an intention-to-treat approach. The meta-analysis is registered with PROSPERO.
Results Among the 19,900 patients recruited in all trials, 17,482 (88%) had LVEF≥50% and were therefore included in this meta-analysis (REBOOT: 7459, REDUCE-AMI: 5020, BETAMI: 2441, DANBLOCK: 2277, CAPITAL-RCT: 285). Of these, 8705 patients (49.8%) were randomized to beta-blockers, and 8777 (50.2%) to control within 14 days of the index MI. A total of 3634 (20.8%) were women, 7794 (44.6%) had a ST-elevation MI, and 16,328 (93.4%) underwent percutaneous coronary intervention. Bisoprolol was used in 49.1%, metoprolol in 46.8%, and carvedilol in 4.8%. A primary endpoint event occurred in 1447 (8.3%). The results will be presented at the AHA congress upon acceptance.
Conclusion This IPD meta-analysis aims to provide a definite answer of whether beta-blocker therapy in patients with a recent MI and preserved LVEF reduces clinical events.
Kristensen, Anna Meta
( Bispebjerg-Frederiksberg Hospital
, Copenhagen
, Denmark
)
Fuster, Valentin
( Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC)
, Madrid
, Spain
)
Hofmann, Robin
( Södersjukhuset
, Stockholm
, Sweden
)
Anna Meta Kristensen:DO NOT have relevant financial relationships
| Valentin Fuster:No Answer
| Robin Hofmann:DO have relevant financial relationships
;
Advisor:AstraZeneca:Past (completed)
; Speaker:MSD:Past (completed)
; Advisor:AstraZeneca:Past (completed)
| Kjell Vikenes:DO NOT have relevant financial relationships
| Michael Maeng:No Answer
| Stuart Pocock:No Answer
| Patric Karlström:No Answer
| Arnhild Bakken:DO have relevant financial relationships
;
Other (please indicate in the box next to the company name):Idorsia/Viatris:Active (exists now)
| Jose A Barrabes:No Answer
| Jocelyne Benatar:DO NOT have relevant financial relationships
| Morten Wang Fagerland:No Answer
| Xavier Rossello:DO NOT have relevant financial relationships
| Therese Lucia Friis Holmager:DO NOT have relevant financial relationships
| Neiko Ozasa:No Answer
| Eva Prescott:DO NOT have relevant financial relationships
| john Munkhaugen:DO NOT have relevant financial relationships
| Tomas Jernberg:No Answer
| Borja Ibanez:DO NOT have relevant financial relationships
| Dan Atar:DO have relevant financial relationships
;
Speaker:Speaker fees: Abbott, Amgen, Amarin, AstraZeneca, Bayer, Boehringer-Ingelheim, BMS, Chiesi, GSK, MSD, Novartis, NovoNordisk, Pfizer, Pharmacosmos, Philips, Roche-Diagnostics, Sanofi, Takeda, Vifor.:Active (exists now)
; Research Funding (PI or named investigator):Speaker fees: AbboGrant support (to the Institution): BMS/Pfizer, Medtronic, Bayer, Roche-Diagnostics.:Active (exists now)
| Troels Yndigegn:No Answer
| Takeshi Kimura:DO NOT have relevant financial relationships
| Roberto Latini:DO NOT have relevant financial relationships
| Bertil Lindahl:DO NOT have relevant financial relationships
| Sigrun Halvorsen:DO have relevant financial relationships
;
Speaker:Novartis:Active (exists now)
; Speaker:Astra Zeneca:Past (completed)
; Speaker:Sanofi:Past (completed)
; Speaker:Novo Nordisk:Active (exists now)
| Michael Hecht Olsen:No Answer
