SynthesisAmerican journal of cardiovascular drugs : drugs, devices, and other interventions2026
Beta-Blockers After Myocardial Infarction Without Reduced Ejection Fraction: A Meta-Analysis of Kaplan-Meier Reconstructed Individual Patient Data.
Synthesis in American journal of cardiovascular drugs : drugs, devices, and other interventions, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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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.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
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Corrections and comments
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe long-term benefit of beta-blockers (β-blockers) after myocardial infarction (MI) in patients with preserved left-ventricular ejection fraction (LVEF ≥ 40%) remains uncertain in the modern reperfusion era. Earlier trials showed mortality benefits, but contemporary therapies may have altered their effect.
methodsWe conducted a meta-analysis of randomized controlled trials (RCTs) comparing β-blockers versus no β-blockers in adults with MI and LVEF ≥ 40%. PubMed, Scopus, Web of Science, and Cochrane CENTRAL were searched through October 2025. Primary outcomes were all-cause mortality, recurrent MI, and heart failure (HF). Individual patient data (IPD) were reconstructed from Kaplan-Meier curves for time-to-event analysis, and pooled risk ratios (RRs) and hazard ratios (HRs) were estimated using random-effects models. Trial sequential analysis (TSA), meta-regression, and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) certainty assessments were performed.
resultsFive RCTs (n = 23,524 patients) met inclusion criteria. β-Blockers did not significantly reduce recurrent acute myocardial infarction (AMI) (HR: 0.89 with 95% confidence interval [CI 0.78, 1.02], P = 0.1), HF (HR: 0.92 with 95% CI [0.71, 1.20], P = 0.54), and all-cause mortality (HR: 0.97 with 95% CI [0.85, 1.10], P = 0.63). Secondary endpoints-including major adverse cardiovascular events (MACE), cardiovascular death, stroke, and revascularization-were neutral (P > 0.05). TSA boundaries were not crossed, and meta-regression identified no significant effect modifiers. Evidence certainty was rated low to moderate.
conclusionsAmong patients with MI and preserved LVEF, β-blockers did not reduce mortality or ischemic or HF events. Routine long-term use offers no prognostic advantage and should be reserved for specific indications such as reduced LVEF, angina, arrhythmia, or hypertension. REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO) identifier no. CRD420251175415.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.