Antecubital Phlebotomy Complicated by Lateral Antebrachial Cutaneous Neuropathy

Beta-Blockers after Myocardial InfarctionTo the Editor: In their report on an observational study of beta-blockade after myocardial infarction, Gottlieb et al. (Aug.20 issue) 1 firmly conclude that beta-blockers should be used for high-risk patients after acute myocardial infarction, including patients with congestive heart failure.This conclusion is not supported by the data presented.The randomized studies of beta-blockers excluded patients with severe heart failure -and all physicians are trained in such contraindications.Therefore, we know that physicians will be reluctant to use beta-blockers in high-risk patients, and we can readily anticipate that the willingness to use a beta-blocker is a marker of low risk, both overall and in subgroups of patients.The authors' demonstration that beta-blockers are associated with a dramatic reduction in risk confirms a self-evident truth, regardless of the huge sample.The authors could have confirmed this explanation by demonstrating that beta-blockers are a marker of good exercise performance, a short hospital stay, and higher social status -other unspecific indicators of low risk.The value of beta-blockers in high-risk patients must be considered uncertain until proper randomized trials have proved otherwise.Such studies are under way in our country and elsewhere, and their completion must be awaited before firm conclusions are drawn.