What happened to intravenous atenolol in acute myocardial infarction?

Randomized clinical trials are essential in objectively assessing treatment options. However, badly designed trials can generate impressive results, and good trial data may be interpreted differently by practicing clinicians. One example of the latter is the use of intravenous atenolol in acute myocardial infarction where, despite a large trial clearly demonstrating that immediate therapy is relatively safe in patients with acute myocardial infarction and reduces in-hospital mortality, its routine use remains extremely variable. The reasons for the poor uptake of atenolol in acute myocardial infarction, including anticipated clinical drawbacks, the way the trial data were published, and the marketing of beta blockers, are discussed in this paper.