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.