Patients with initial contraindications to beta blockers in the first 24 h after an AMI should be reevaluated to determine their subsequent eligibility. A systematic review of randomized controlled trials inclusive of 54234 patients with acute or prior MI demonstrated that beta blockers are effective in secondary prevention after MI and impart a 23% reduction in the odds of death in long-term trials.48 Notably, the evidence is established predominantly in the pre-reperfusion era among patients with STEMI. The effects of beta blockers appear also to be greatest among patients with MI complicated by heart failure, systolic cardiomyopathy, or ventricular arrhythmias.48 Although not prospectively studied, the AHA/ACCF secondary prevention guidelines recommend a 3-year treatment course with beta blockers for patients with Many of these patients, however, have either hypertension or heart failure/systolic cardiomyopathy, and are usually continued on an oral beta blocker indefinitely. It is advisable to use beta blockers without intrinsic sympathomimetic activity, and in patients with MI complicated with systolic cardiomyopathy with or without heart failure, 1 of the 3 proven beta blockers should be used: carvedilol, sustained-release metoprolol succinate, or bisoprolol. Clinical Recommendation(s) 2013 ACCF/AHA Guideline for the Management of Patients With ST-Elevation Myocardial Infarction12 1. Beta blockers should be continued during and after hospitalization for all patients with STEMI and with no contraindications to their use.48,49 (Class I, Level of Evidence: B) 2014 AHA/ACC Guideline for the Management of Patients With Non ST-Elevation Acute Coronary Syndromes11 1. In patients with concomitant NSTE-ACS, stabilized HF, and reduced systolic function, it is recommended to continue beta-blocker therapy with 1 of the 3 drugs proven to reduce mortality in patients with HF: sustained-release metoprolol succinate, carvedilol, or bisoprolol. (Class I, Level of Evidence: C) 2. 