DOI: https://doi.org/10.36347/sasjm.2026.v12i02.008

Pages: 119-122

Background: β-blockers have long been a cornerstone of secondary prevention after myocardial infarction (MI), based largely on randomized trials conducted in the pre-reperfusion era. However, major advances in acute coronary care, including early revascularization, optimized antithrombotic therapy, and widespread statin use, have raised uncertainty regarding the role of long-term β-blocker therapy in contemporary post-MI patients, particularly those with preserved left ventricular ejection fraction (LVEF). Objective: This review aims to reassess the evidence supporting long-term β-blocker therapy after MI in the modern era, with particular focus on patient subgroups defined by left ventricular systolic function. Methods: Reviewed contemporary randomized controlled trials, meta-analyses, and international guideline recommendations evaluating the impact of β-blocker therapy after MI in the reperfusion era. Special emphasis was placed on recent individual-patient data (IPD) meta-analyses pooling major randomized trials. Results: Historical trials demonstrated clear mortality benefits of β-blockers after MI; however, these findings may not be fully applicable to current practice. Contemporary evidence suggests that the prognostic benefit of β-blockers is largely confined to patients with impaired or mildly reduced LVEF. A recent IPD meta-analysis pooling the REBOOT, BETAMI, DANBLOCK, and CAPITAL-RCT trials demonstrated a significant reduction in major cardiovascular events among patients with mildly reduced LVEF (40–49%), while no consistent benefit was observed in patients with preserved LVEF (≥50%). These findings help reconcile previously conflicting trial results and support a stratified, phenotype-driven approach to β-blocker therapy after MI. Conclusion: In the contemporary era of myocardial infarction management, long-term β-blocker therapy should no longer be considered universal. While β-blockers remain strongly indicated in patients with reduced or mildly redu