Exploring the Impact of Beta-Blockers Post-Acute Myocardial Infarction in Patients with Preserved Ejection Fraction: A Meta-Analysis

Exploring the Impact of Beta-Blockers Post-Acute Myocardial Infarction in Patients with Preserved Ejection Fraction: A Meta-Analysis

J. Clin. Med. 2025, 14(11), 3969; https://doi.org/10.3390/jcm14113969

 Abstract

Background/Objectives: Previous research has establishedthat beta-blockers significantly reduce all-cause mortality, cardiovascular mortality, and recurrent acute myocardial infarction (AMI) in patients with left ventricular dysfunction following AMI. However, their efficacy in patientswith preserved left ventricular ejection fraction (LVEF) who undergo timely reperfusion and revascularization while receiving evidence-based medical management remains inconclusive. To address this uncertainty, we conducted asystematic review and meta-analysis to synthesize the available evidence on the impact of beta-blocker therapy in patients with acute myocardial infarction andpreserved left ventricular ejection fraction.

Methods: A comprehensive literature search was conductedacross PubMed, the Web of Science, and Scopus from their inception until November 2024. The search strategy incorporated three primary keywords and their corresponding Medical Subject Headings (MeSH) terms: “preserved”, “myocardial infarction”, and “beta-blocker”. Data analysis was performed using Review Manager 5.4 software. A random-effects model was applied to account forthe study’s heterogeneity, while a fixed-effects model was utilized for homogeneous outcomes. Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated for dichotomous outcomes, with a 95% confidence interval (CI) and a significance threshold of p < 0.05.

Results: Beta-blocker therapy was significantly associatedwith a reduction in all-cause mortality compared to non-use, with an OR of 0.73 (95% CI: 0.61–0.88, p = 0.001) and an HR of 0.78 (95% CI: 0.67–0.91, p = 0.002). Similarly, beta-blockeradministration was linked to a lower risk of cardiovascular mortality, demonstrating an OR of 0.76 (95%CI: 0.68–0.84, p < 0.00001) and an HR of 0.76 (95% CI: 0.59–0.99, p = 0.04). Furthermore, beta-blocker use was significantly correlated with a decreased risk of majoradverse cardiovascular events (MACEs) compared to non-use, with an OR of 0.84 (95% CI: 0.75–0.95, p = 0.004)and an HR of 0.84 (95% CI: 0.71–0.99, p = 0.04).

Conclusions: The current meta-analysis suggestsa potential beneficial association between beta-blocker use and outcomes in patients with acute myocardial infarction and preserved left ventricular ejection fraction, including lower rates of all-cause mortality, cardiovascularmortality, and MACEs; however, these findings should be interpreted with caution due to the observational nature of most included studies. Therefore, further randomized controlled trials (RCTs) are needed to confirm thesefindings, particularly in distinguishing outcomes among patients with and without heart failure.Disclaimer:

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