β-Adrenergic Antagonists in the Management of Acute Myocardial Infarction

Despite significant advances in therapy, coronary artery disease is still the leading cause of mortality in the western world. Since the Goteborg metoprolol trial [1], several others have confirmed the beneficial effects of β-blockers in acute myocardial infarction. These range from a 13% reduction in mortality in the first 24 h after early intravenous β-blockade [2] to substantial reductions in mortality and morbidity resulting from chronic, long-term therapy in post-myocardial infarction patients. Although most of these trials were conducted in the pre-thrombolytic era, there is evidence to suggest that β-blockers, administered early in the post-myocardial infarction period offer significant benefits even to thrombolysed patients. The introduction of β-blockers with multiple actions such as carvedilol is likely to significantly extend their role in acute myocardial infarction and coronary artery disease.