βBlockade after myocardial infarction

EDITOR—Freemantle et al show good evidence that long term — blockade is an effective and well tolerated treatment that reduces mortality and morbidity in unselected patients after myocardial infarction.1 They present data for the end points all cause mortality and non-fatal reinfarction but make no specific reference to sudden death. They quote the results of 31 long term trials; we have been able to find data on sudden death in only 13 of these.

Sudden death is common and an important cause of death in the major long term trials after myocardial infarction. In the 13 trials that included data on sudden death the average incidence of sudden death in the placebo treated group was 51% (table). The corresponding figure in the groups treated with a β blocker was 43%. Although this suggests that β blockers do reduce the risk of sudden death, these mean figures probably grossly underestimate …