ReviewCureus2026
Treatment Effect of Beta-Blocker Therapy After Acute Myocardial Infarction With Preserved or Mildly Reduced Ejection Fraction: A Systematic Review and Trial Sequential Analysis.
Review in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Long-term use of beta-blockers has been the standard of care after acute myocardial infarction (AMI), but evidence comes largely from pre-reperfusion-era trials in patients with reduced left ventricular ejection fraction (LVEF). With modern reperfusion and optimal secondary prevention, the benefit in patients with preserved and mildly reduced LVEF remains uncertain. Most guidelines continue to recommend routine beta-blocker use in this population, yet no prior meta-analysis has been restricted to recent randomized controlled trials (RCTs). The objective of this article was to evaluate the efficacy and safety of beta-blocker versus no beta-blocker therapy after AMI in patients with preserved or mildly reduced LVEF. The Cochrane Central, PubMed, Embase, and ClinicalTrials.gov were searched for RCTs that compared beta-blocker versus no beta-blocker therapy after AMI in patients with preserved LVEF (≥50%) or mildly reduced LVEF (40-49%). The primary outcome was major adverse cardiovascular events (MACE); secondary outcomes included all‑cause mortality, cardiac death, myocardial infarction (MI), unplanned revascularization, heart failure (HF) events, malignant ventricular arrhythmia, and stroke. Trial sequential analysis (TSA) was performed to assess the conclusiveness of the evidence and whether further trials are warranted. Four RCTs comprising 19,826 patients (BB (beta blocker), n = 9892; no BB, n = 9934) were included. Beta-blockers did not significantly reduce MACE (RR 0.95, 95% CI 0.87-1.03). No difference was observed in all-cause mortality (RR 0.98, 95% CI 0.86-1.13), cardiac death (RR 1.15, 95% CI 0.88-1.51), MI (RR 0.88, 95% CI 0.75-1.04), unplanned revascularization (RR 1.01, 95% CI 0.88-1.16), HF events (RR 0.83, 95% CI 0.64-1.08), malignant ventricular arrhythmia (RR 0.84, 95% CI 0.47-1.50), or stroke (RR 1.18, 95% CI 0.85-1.64). Heterogeneity was low across outcomes. TSA demonstrated that the cumulative evidence for all-cause mortality, unplanned revascularization, and malignant ventricular arrhythmia was conclusive, while MACE and other outcomes remain inconclusive. In AMI patients with preserved or mildly reduced LVEF, beta-blockers did not reduce ischemic events, mortality, or arrhythmia. TSA suggests that additional trials are unlikely to alter conclusions for mortality and revascularization, but uncertainty persists for composite outcomes.
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