Mount Sinai Med-Lit Review
Clinical question: Are beta-blockers beneficial in patients discharged after receiving invasive care for a myocardial infarction (MI) and with preserved left ventricular ejection fraction (ejection fraction greater than 40%)?
Background: Current guidelines recommend discharging all patients with MI on a beta-blocker irrespective of the left ventricular function, and were based on trials conducted before invasive care and advanced pharmacologic therapies were standard practice.
Study design: Open-label, randomized trial
Setting: Patients discharged after MI and with an ejection fraction greater than 40% in Spain and Italy
Synopsis: Initially, 4,243 patients were randomly assigned to receive beta-blocker therapy, and 4,262 received no beta-blocker. After exclusions, 8,438 patients were included in the analysis, and the median follow-up was 3.7 years. The primary outcome was a composite of death from any cause, reinfarction, or hospitalization for heart failure. No significant difference in safety outcomes was noted in the two groups, with hazard ratios of 1.04,1.06, 1.01, and 0.89, respectively, for the occurrence of the primary outcome events and for each of the primary outcome measures.
Bottom line: For patients who were discharged after receiving invasive care for MI and who had a left ventricular ejection fraction above 40%, beta-blocker therapy appeared to provide no added benefit in reducing mortality from any cause, reinfarction events, or hospitalizations for heart failure.
Citation: Ibanez B, et al. Beta-blockers after myocardial infarction without reduced ejection fraction. N Engl J Med. 2025;393(19):1889-1900. doi: 10.1056/NEJMoa2504735.
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Dr. Kulkarni
Dr. Kulkarni is the chair of hospitalist services at the Valley Hospital in Paramus, N.J., and a clinical assistant professor of hospital medicine at Mount Sinai Hospital and the Icahn School of Medicine at Mount Sinai, both in New York.