Should be used in combination with thrombolysis

In the 1980s two large randomised controlled trials showed a reduction in early mortality when intravenous βblockers were given acutely to patients presenting with suspected myocardial infarction, 12 and the use of β blockers in acute myocardial infarction has since been recommended.3 Yet intravenous β blockade is rarely used in Britain. In the ISIS-4 trial, for example, it was given to only 5% of patients enrolled in Britain compared with about 30% of those enrolled in Italy and America.4 This is consistent with anecdotal evidence that few British hospitals routinely use intravenous β blockade in acute myocardial infarction.

The evidence is persuasive. In the Gothenburg metoprolol trial, metoprolol 15 mg was given intravenously as soon as possible after the arrival of the patient in hospital followed by oral metoprolol 100 mg twice daily.1 At 90 days there was a 36% reduction in total mortality in the group treated with metoprolol. In ISIS-1 atenolol 10 mg was given intravenously immediately on admission followed by …