The Use of β-Blockers After Myocardial Infarction

DESPITE a decreasing incidence of coronary artery disease, myocardial infarction remains the leading cause of death in the industrialized nations of the world, with more than a half million deaths yearly in the United States alone. While much of the mortality occurs within the first few hours after infarction, there is also a very high death rate during the following six months (Fig 1). Mortality among infarct victims who survive the first week is still in the range of 15% in the first year (depending on the presence of various risk factors, this may range from 2% to upward of 50%) and may be 3% to 4% per year thereafter. The concept of prevention of reinfarction and death after myocardial infarction, ie, secondary prevention, has been actively investigated for the past two decades. Until quite recently, however, almost all efforts at demonstrating secondary prevention had failed. Thus, studies of antiplatelet