ArticleJACC. Advances2026
Beta-Blocker Discontinuation After Myocardial Infarction: A Systematic Review and Meta-Analysis.
Article in JACC. Advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
10 authors.
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Abstract
backgroundBeta-blockers after myocardial infarction (MI) are being questioned, specifically among persons with preserved left ventricular ejection fraction (LVEF). This raises consideration for beta-blocker discontinuation.
objectivesThe objective of this study was to conduct a systematic review and meta-analysis examining the effects of discontinuation vs continuation of beta-blockers after MI.
methodsWe searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Google Scholar, Epistemonikos from inception to September 11, 2025. Eligible studies were randomized controlled trials and nonrandomized studies among adults ≥18 years. Outcomes included mortality and major adverse cardiovascular (CV) events (MACE), as well as its components. We performed meta-analyses using an inverse-variance random-effects model and evaluated certainty of evidence using Grading of Recommendations, Assessment, Development, and Evaluation.
resultsWe screened 4,103 titles/abstracts, and 10 studies were eligible (1 randomized controlled trial, 9 observational studies; N = 121,114). Eight studies involved patients with LVEF >40% and/or without heart failure. Compared with beta-blocker continuation, discontinuation might not be associated with increased risk of mortality (HR: 1.11; 95% CI: 0.96-1.28; 8 studies; low certainty evidence). Discontinuation might be associated with increased risk of MACE compared with continuation (HR: 1.12; 95% CI: 1.01-1.24; 7 studies; low certainty; driven by increased risk of CV hospitalizations) but might not be associated with an increased risk of MI (HR: 1.39; 95% CI: 0.95-2.04; 5 studies; low certainty).
conclusionsAmong post-MI patients with LVEF >40% and without heart failure, beta-blocker discontinuation might not increase risk of mortality or MI, though there may be an increased risk of MACE primarily due to CV hospitalizations.
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