Long‐Term Beta‐Blocker Therapy after Myocardial Infarction in the Reperfusion Era: A Systematic Review
Bibliographic record
Abstract
Beta-blockers are recommended as standard of care for patients who experience a myocardial infarction (MI). However, evidence to support this recommendation is primarily derived from the pre-reperfusion era. In the reperfusion era, short-term (≤ 30 days) beta-blocker therapy has been demonstrated to reduce recurrent MI and angina, but not mortality. The objective of this review was to evaluate the evidence for long-term (≥ 1 yr) beta-blocker therapy in patients post-MI without left ventricular dysfunction in the reperfusion era. A systematic search of MEDLINE, EMBASE, CENTRAL, and Google from inception to September 2017 was performed. Included were randomized controlled trials and observational propensity score cohort studies published within the past 10 years that compared beta-blockers to placebo/no beta-blockers at discharge in patients with an acute MI but without left ventricular dysfunction or heart failure. Outcomes of interest included all-cause and cardiovascular mortality, nonfatal MI, and nonfatal stroke. Eight cohort studies were included. Follow-up ranged from 1 to 5 years. Two smaller studies demonstrated a reduction in all-cause mortality with beta-blockers, whereas there was no difference observed in six studies. One study showed reduced cardiovascular mortality at 1 year, but no difference in sudden cardiac death. One study demonstrated a reduction in cardiac mortality at 3 years, but no difference in MI or stroke. None of the four studies that reported adverse cardiovascular events demonstrated a benefit with beta-blocker therapy. Though these data are limited by observational methodology, the majority of the included studies failed to demonstrate a benefit in survival or cardiovascular events with long-term beta-blockers in post-MI patients with normal left ventricular function. In the absence of a contemporary randomized controlled trial, this evidence imparts uncertainty regarding the current standard of care and suggests that it may be reasonable to discontinue beta-blockers in patients without impaired left ventricular function at 1-year post-MI who do not have another indication for use.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.014 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.006 |
| Bibliometrics | 0.005 | 0.007 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".