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Since the last quarter of the 20th century, beta-blockers have been considered a cornerstone therapy after acute coronary syndrome (ACS), alongside reperfusion therapy, antiplatelet agents, statins and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. Together, these therapies have led to striking improvements in the outcome of these syndromes, in terms of both mortality and morbidity. More recent advances in organizational models of response to ACS and in reperfusion therapy, with wider availability of percutaneous coronary intervention (PCI) replacing pharmacological reperfusion therapy, have led to further significant reductions in mortality and morbidity, particularly in terms of heart failure and mechanical complications following myocardial infarction (MI). With every new advance in this field, researchers should question old dogmas and reassess previous strategies, pro-

The dilemma of beta-blocker use after acute coronary syndrome: To support the dogma or to embrace the paradigm shift?