Is there still a role for treatment with beta-adrenoceptor antagonists in post-myocardial infarction patients with well-preserved left ventricular systolic function?

The utility of β-adrenoceptor antagonists post myocardial infarction was established in the pre-thrombolytic era. Evidence for improvement in long-term prognosis with metoprolol, timolol and propranolol in particular derives from reduction in event rates in patients who have had substantial left ventricular damage at the time of infarction and probably correlates largely with the more recently demonstrated salutary effects of this group of drugs in patients with chronic heart failure. In all other respects, evidence for beneficial effects of β-adrenoceptor antagonists in peri-infarct and post-infarct therapeutics is equivocal. They appear to exert no major influence on outcomes in patients with unstable angina, nor do they markedly alter early clinical course in uncomplicated acute myocardial infarction, irrespective of other interventions. Furthermore, the limited available analyses suggest no discernible beneficial effect on long-term outcomes post-uncomplicated infarction. It is possible that in such patients, current recommendations for 'routine' long-term β-adrenoceptor blockade can no longer be justified.John D. Horowitz, Margaret A. Arstall, Christopher J. Zeitz, John F. Beltram