Critical appraisal of secondary prevention after myocardial infarction. What have beta-blockers to offer in the experimental situation?

This contribution reviews the beneficial effects of beta-adrenoceptor blocking drugs in experimental myocardial ischaemia (infarction). These effects include the ability to reduce early, life-threatening ventricular arrhythmias, improvement in ultimate long-term survival from an ischaemic insult with or without subsequent reperfusion and a reduction in the extent and degree of myocardial (and microvascular) ischaemic damage. Most of the evidence for protection, however, comes from studies in which drugs have been administered before the onset of ischaemia. Much less is known about the effects of intervening with beta-blocking drugs after the commencement of the ongoing infarction process. Although beta-blockers have a great deal to offer in the experimental situation there remains the strong possibility that other approaches might be able to offer even more. One promising approach is the combination of a beta-blocking drug with a specific inhibitor of thromboxane synthesis.