β-Blockers Reduce Death, MI, Heart Failure 25% in Mildly Reduced LVEF: Latest Meta-Analysis Presented at ESC Congress 2025
β-blocker therapy results in a 25% reduction in the composite outcome of all-cause death, new myocardial infarction, or heart failure in patients with acute myocardial infarction and mildly reduced left ventricular ejection fraction (40-49%) without history or clinical signs of HF, a recent meta-analysis has reported. This patient-level meta-analysis pooled data from four RCTs — REBOOT, BETAMI, DANBLOCK, and CAPITAL-RCT — conducted across five countries. It included 1,885 patients with LVEF 40–49% (median age 63 years) who had recent MI (≤14 days) without heart failure, randomized to β-blockers or no β-blockers, with a median follow-up of more than 1 year.Of these, 991 patients (53%) were randomized to β-blocker therapy and 894 (47%) to no β-blocker therapy, of whom 991 (53%) were randomized to β-blockers and 894 (47%) to no β-blockers, with a median follow-up of more than 1 year. The major beta-blocker noted in the study was metoprolol (49%). The findings were presented at the recently concluded ESC Congress 2025, Madrid, Spain; and have been published in The Lancet (August 2025). The primary endpoint included a composite of all-cause death, new myocardial infarction, or heart failure. Key secondary endpoints included the individual components of the primary composite (all-cause death, new MI, heart failure), cardiac death, unplanned coronary revascularization, malignant ventricular arrhythmias, and safety outcomes, including stroke and advanced atrioventricular block. Key results of the study are Figure 1: Cumulative incidence of primary endpoint Overall, the findings support the use of β-blockers in patients with myocardial infarction and mildly reduced LVEF, highlighting their role as an effective long-term secondary prevention therapy. This study expands the current evidence on the benefits of initiating β blockers in patients with recent myocardial infarction with reduced LVEF (≤40%) by demonstrating that those with mildly reduced LVEF (40–49%) also derive clinical benefit. Further research should focus on patients with preserved LVEF (≥50%) Reference:Rossello X, Prescott EIB, Kristensen AMD, Latini R, Fuster V, Fagerland MW, et al. β blockers after myocardial infarction with mildly reduced ejection fraction: an individual patient data meta-analysis of randomised controlled trials. Lancet. 2025 Aug 30. doi: 10.1016/S0140-6736(25)01592-2. [Epub ahead of print]
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