Favorable effects of intravenous beta blockers in ST elevation myocardial infarct: time for a revival?

Introduction A wealth of data in the literature support the long-term use of beta blockers after ST elevation myocardial infarct (STEMI). The use of these drugs intravenously in the early phase after the infarct or before reperfusion, though, is not supported by much evidence. In fact, despite the solid mechanistic hypothesis (reduction of the heart rate, contractility, oxygen consumption, and the modulation of the reperfusion damage signaling, Fig. 1), proven in animal models (decreased infarct size), the scientific evidence for their efficacy in clinical practice has been difficult to come by. Accordingly, present guidelines recommend intravenous beta blockers as potentially useful, in the acute phase after myocardial infarct, in hemodynamically stable patients without contraindication to the treatment (class IIa, level of evidence B).