For more than a quarter of a century, beta-blockers have been a cornerstone in the treatment of patients with myocardial infarction. The American college of cardiology foundation/American heart association (ACCF/ANH) ST-elevation myocardial infarction guideline gives a class I recommendation for oral beta-blockers within the first 24 hours in patients with myocardial infarction, and a class IIa indication for intravenous beta-blockers for patients who are hypertensive or having ongoing ischemia. Not surprisingly, the centers for Medicare and Medicaid services, the national committee for quality assurance, the national quality forum, and the joint commission on accreditation of healthcare organizations have adopted beta-blockers use at discharge post myocardial infarction as a quality indicator