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carvedilol Beta blockers following an MI by decade 1980s Beta-Blocker Heart Attack Trial or BHAT (1982) Multicenter, randomized, double-blind, placebo-controlled trial Evaluated the effect of propranolol on mortality in patients who had survived an acute myocardial infarction Population: 3,837 patients within 521 days after myocardial infarction Randomization: propranolol (180240 mg/day in divided doses) or placebo Maintenance dose was determined based on serum drug levels Primary endpoint: total mortality during an average follow-up of 27 months Outcome: Propranolol significantly reduced total mortality compared to placebo Greatest benefit observed in patients at higher risk, such as those with persistent ST-segment depression on ECG after infarction Clinical impact: Established long-term beta-blocker therapy as a standard of care for secondary prevention after myocardial infarction, especially in high-risk subgroups 1990s CAPRICORN (Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction) trial (2001) Multicenter, randomized, double-blind, placebo-controlled study Evaluated carvedilol in patients with left ventricular ejection fraction (LVEF) 40% after acute myocardial infarction (MI) Population: 1,959 patients were enrolled 321 days post-MI, all clinically stable and already receiving standard post-MI therapy, including ACE inhibitors, aspirin, and statins Approximately half had clinical heart failure at baseline