Continuation vs Withdrawal of Beta-Blockers and Outcomes After Myocardial Infarction With Preserved Left Ventricular Function
Bibliographic record
Abstract
BACKGROUND: The role of routine beta-blocker (BB) use after uncomplicated acute myocardial infarction (AMI) treated with contemporary therapies is not well established. OBJECTIVES: The authors conducted a retrospective cohort study using linked registry and administrative data to evaluate whether early BB discontinuation (a prescription ending within 180 days of discharge) is associated with clinical outcomes. METHODS: We included patients who survived at least 180 days after AMI from 2008 to 2017 with new BB prescription and left ventricular ejection fraction ≥50%. The primary outcome was a composite of recurrent AMI, myocardial revascularization, or all-cause mortality within 5 years. Secondary outcomes were each of the components of the composite. Cox proportional hazard models were used to evaluate the association between early BB discontinuation and outcomes. RESULTS: Among the 4,768 included patients, 1,155 (24.2%) discontinued BB within 180 days of AMI discharge. During a median follow-up time of 57 months, 964 patients (20.2%) experienced the primary outcome. Early BB discontinuation was not associated with an increased risk of the primary outcome (adjusted HR: 1.09; 95% CI: 0.94-1.26), or with all-cause mortality (HR: 1.04; 95% CI: 0.86-1.26). However, early BB discontinuation was associated with an increased risk for recurrent AMI and a higher rate of repeat revascularization. CONCLUSIONS: In patients with preserved left ventricular ejection fraction after AMI, discontinuation of BB within 180 days was not associated with a significantly increased risk of a composite outcome of death, recurrent AMI, or revascularization but was associated with increased risk of recurrent AMI and need for repeat revascularization.
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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 | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".