Beta-Blockers After Myocardial Infarction With Preserved and Mildly Reduced Ejection Fraction: A Meta-Analysis With Trial Sequential Analysis.
M, M., P, G., C, T., F, M., L, L., S, K., V, S., S, B., M, E., & D, D.V. (2026). Beta-Blockers After Myocardial Infarction With Preserved and Mildly Reduced Ejection Fraction: A Meta-Analysis With Trial Sequential Analysis.. European journal of clinical investigation. https://doi.org/10.1111/eci.70238
M M, P G, C T, F M, L L, S K, et al. Beta-Blockers After Myocardial Infarction With Preserved and Mildly Reduced Ejection Fraction: A Meta-Analysis With Trial Sequential Analysis.. European journal of clinical investigation. 2026; doi: 10.1111/eci.70238
M M, P G, C T, et al. Beta-Blockers After Myocardial Infarction With Preserved and Mildly Reduced Ejection Fraction: A Meta-Analysis With Trial Sequential Analysis.[J]. European journal of clinical investigation. 2026. DOI: 10.1111/eci.70238.
@article{m2026,
author = {Maremmani M and Gianfico P and Templin C and Montecucco F and Liberale L and Kraler S and Schweiger V and Berti S and Emdin M and Di Vece D},
title = {Beta-Blockers After Myocardial Infarction With Preserved and Mildly Reduced Ejection Fraction: A Meta-Analysis With Trial Sequential Analysis.},
journal = {European journal of clinical investigation},
year = {2026},
doi = {10.1111/eci.70238},
note = {PMID: 42310876},
}
TY - JOUR AU - Maremmani M AU - Gianfico P AU - Templin C AU - Montecucco F AU - Liberale L AU - Kraler S AU - Schweiger V AU - Berti S AU - Emdin M AU - Di Vece D TI - Beta-Blockers After Myocardial Infarction With Preserved and Mildly Reduced Ejection Fraction: A Meta-Analysis With Trial Sequential Analysis. T2 - European journal of clinical investigation PY - 2026 DO - 10.1111/eci.70238 AN - PMID:42310876 ER -
AIMS: We aimed to evaluate the efficacy of β-blockers after myocardial infarction (MI) across left ventricular ejection fraction (LVEF) strata and to assess the conclusiveness of the available evidence using trial sequential analysis (TSA). METHODS: PubMed, Embase and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) evaluating β-blockers in post-MI patients with LVEF ≥ 40%. A time-to-event meta-analysis was performed for the primary composite (as defined by each trial) and for individual endpoints. The Mantel-Haenszel method was used to pool risk ratios (RR) for major adverse cardiovascular events (MACE; death, MI or heart failure), including LVEF-stratified analyses. TSA estimated the required information size (RIS) and generated adjusted significance and futility boundaries, assuming a 5% type I error and 90% power. RESULTS: Across 19,826 post-MI patients (17,941 with LVEF ≥ 50% and 1885 with LVEF 40%-49%), β-blockers did not reduce time to the primary endpoint (HR 0.92, 95% CI 0.85-1.01; p = 0.08; I2 = 35%) or mortality. In patients with preserved LVEF (≥ 50%), β-blocker therapy did not reduce the risk of death or MACE (RR 0.96, 95% CI 0.87-1.05; I2 = 42%), with TSA confirming futility. Among those with mildly reduced LVEF (40%-49%), β-blockers reduced MACE (RR 0.74, 95% CI 0.58-0.94; I2 = 0%), although TSA failed to establish conclusiveness (RIS of 5717 [14.4%]). A significant interaction by LVEF subgroup was observed for cardiac death (p = 0.03). CONCLUSIONS: β-blockers conferred no benefit in post-MI patients with preserved LVEF, with conclusive evidence of futility, whereas therapy was associated with reduced MACE in those with mildly reduced LVEF, pending confirmation in further adequately powered randomized trials.