META-ANALYSIS EVALUATES RECENT CONFLICTING BETA-BLOCKER TRIALS
February 2026
Beta-blocker therapy has been the standard of care after myocardial infarction (MI) based on trials from the early 1980s, before modern reperfusion and intensive medical therapy. With advances in acute coronary care, the role of long-term beta-blockers in patients with chronic coronary artery disease (CAD) and preserved left ventricular ejection fraction (LVEF) has been uncertain. Four large, recent randomized trials—REBOOT-CNIC, REDUCE-AMI, BETAMI-DANBLOCK, and ABYSS—have evaluated beta-blockers in this population and reached conflicting conclusions: some reported a benefit on composite outcomes, while others found no significant effect. When individual trials disagree, meta-analyses can combine results to estimate an overall effect. To provide a perspective on the conflicting results, researchers performed an individual-patient-data meta-analysis that included three of these trials (REBOOT-CNIC, REDUCE-AMI, and BETAMI-DANBLOCK).
The Beta-Blocker Trialists' Collaboration meta-analysis pooled data from 17,801 patients with a recent MI and LVEF> 50% who were randomly assigned to beta-blocker therapy or no beta-blocker therapy: REBOOT (7459), REDUCE-AMI (4967), BETAMI (2441), DANBLOCK (2277), and CAPITAL-RCT (657). The primary endpoint was a composite of death from any cause, myocardial infarction, or heart failure, and patients were followed for a median of 3.6 years. A primary-endpoint event occurred in 8.1% of the beta-blocker group and 8.3% of the no–beta-blocker group (hazard ratio [HR], 0.97; 95% CI, 0.87 to 1.07; P=0.54). For the components, death from any cause occurred in 3.8% vs 3.6% (HR 1.04; 95% CI, 0.89 to 1.21), MI in 4.1% vs 4.5% (HR 0.89; 95% CI, 0.77 to 1.03), and heart failure in 0.8% vs 1.0% (HR 0.87; 95% CI, 0.64 to 1.19). Between-trial heterogeneity was low (I² 20%). Results were consistent in sensitivity analyses (two-stage random-effects model, adjusted Cox regression, and exclusion of the trial without adjudicated MI/HF events).
While meta-analyses are observational and have many limitations, including differing criteria, protocols, and outcome definitions, they can be useful in cases like this one, where large trials yield conflicting results and individual-patient data are available for review. This meta-analysis adds weight to the null hypothesis that, in patients with recent MI, LVEF > 50%, and no other indication for beta-blockers, long-term beta-blocker therapy is not beneficial. This supports reassessing the need for beta-blockers in such patients rather than continuing them indefinitely by default.
