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Coronary disease & ACSRandomised controlled trial

Beta-Blockers after Myocardial Infarction in Patients without Heart Failure

N Engl J MedPublished

  • Randomised controlled trial
  • open-label
  • blinded end-point evaluation
  • Denmark and Norway
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Authors' conclusion

Among patients with a myocardial infarction and a left ventricular ejection fraction of at least 40%, beta-blocker therapy led to a lower risk of death or major adverse cardiovascular events than no beta-blocker therapy.

Study context

Population
Patients with MI and LVEF ≥40%
Participants
5,574 patients
Comparison
Long-term beta-blocker vs no beta-blocker after MI
  • Beta-blockern = 2,783
  • No beta-blockern = 2,791reference
Primary endpoint
Death from any cause or MACE (new MI, unplanned coronary revascularization, ischemic stroke, HF, or malignant ventricular arrhythmias)
Follow-up
Median 3.5 years (IQR 2.2 to 4.6)

Primary result

As reported in the abstract

Hazard ratio

0.85

95% CI 0.75–0.98

P = 0.03

Events by treatment group

Beta-blocker vs No beta-blocker
HR 0.85 (95% CI 0.75–0.98); P = 0.03

Further findings

Death from any cause

Unplanned coronary revascularization

Ischemic stroke

HF

Malignant ventricular arrhythmias

OutcomeBeta-blockerNo beta-blockerHR (95% CI)
MI5.0%6.7%0.73 (0.59–0.92)

Safety

Safety outcomes

No apparent differences in safety outcomes between groups

Original publication

Beta-Blockers after Myocardial Infarction in Patients without Heart Failure. N Engl J Med. Published 30 August 2025. doi:10.1056/nejmoa2505985
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Summarised from the published abstract; every number is checked against it