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Background Long-term beta-blocker therapy has historically been recommended following acute myocardial infarction (AMI) to reduce mortality and recurrent ischemic events. In the contemporary era of routine percutaneous coronary intervention and optimized guideline-directed medical therapy, a substantial proportion of patients recover with preserved left ventricular ejection fraction (LVEF), rendering the benefit of prolonged beta-blocker therapy in this population uncertain.Methods A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, Cochrane Library, and Google Scholar were searched. Statistical analyses were performed using RevMan version 5.4, applying a random-effects model to pool risk ratios (RRs) with 95% confidence intervals (CIs). A p-value <0.05 was considered statistically significant.Results Five RCTs, comprising 23,524 participants (11,744 receiving beta-blockers and 11,780 controls) were included. Over a mean follow-up of three years, beta-blocker therapy showed no significant effect on all-cause mortality (RR 0.98, 95% CI: 0.87–1.11) or cardiovascular mortality (RR 1.06, 95% CI: 0.83–1.36). Similarly, no significant differences were observed for secondary outcomes: major adverse cardiovascular events (MACE) (RR 0.96, 95% CI: 0.85–1.07), recurrent myocardial infarction (RR 0.89, 95% CI: 0.78–1.02), stroke (RR 1.27, 95% CI: 0.92–1.76), or hospitalizations for heart failure (RR 0.77, 95% CI: 0.56–1.05) ( figures 1 and 2).Conclusion In patients with acute myocardial infarction and preserved LVEF, long-term beta-blockers showed no reduction in mortality, recurrent MI, stroke, MACE, or HF admissions, indicating limited routine benefit. Future large-scale, rigorously designed randomized trials are warranted to clarify their role in long-term secondary prevention.Abstract 316 Figure 1Forest plots for (A) all-cause mortality, (B) MACE, and (C) recurrent MIAbstract 316 Figure 2Forest plots for (A) cardiovascular mortality, (B) stroke, and (C) hospitalizations for heart failure