Effectiveness of Beta-Blockers in Reducing Mortality and Recurrence After Myocardial Infarction: A Systematic Review of Contemporary and Foundational Evidence.

Abstract

Beta-blockers have traditionally been a mainstay in the management of patients recovering from myocardial infarction (MI). However, their role in the era of modern cardiac interventions remains a topic of active discussion. This systematic review evaluated evidence from 1983 to 2014, drawn from PubMed, Embase, Scopus, and CENTRAL, on the effectiveness of beta-blockers in reducing mortality and recurrent cardiovascular events in adults following MI. After a comprehensive screening process, four eligible studies (two randomized controlled trials, one post hoc analysis, and one observational study) were included, encompassing a total of 19,078 participants with varied clinical settings and patient profiles. Across these studies, beta-blocker therapy was consistently associated with reductions in all-cause mortality, cardiovascular mortality, and recurrent MI, particularly among individuals with reduced left ventricular function. Some benefit was also observed in those with preserved function, though with less consistency. The magnitude of benefit included a 23-26% reduction in overall mortality and up to a 41% reduction in recurrent MI. Despite differences in study design, patient characteristics, and treatment protocols, the overall findings support the continued use of beta-blockers in post-infarction care. Limitations included heterogeneity in populations, beta-blocker regimens, and study eras, highlighting the need for individualized treatment approaches. Nonetheless, these results align with current guidelines from the American College of Cardiology/American Heart Association and the European Society of Cardiology, reaffirming the relevance of beta-blockers in improving outcomes in this patient population.