The efficacy of beta blockers in managing patients with post-acute myocardial infarction (AMI) was established based on randomized controlled trials predating the era of modern therapy in Western populations. We compared the effects of beta blockers on cardiovascular events with those of calcium antagonists in Japanese post-AMI patients on modern reperfusion therapy by performing a multicenter, prospective, randomized, open-blind end point study. Five hundred forty-five patients were assigned to the beta-blocker group and 545 patients to the calcium antagonist group. The mean follow-up period was 455 days. There was no significant difference in the incidence of cardiovascular death (1.7% vs 1.1%), reinfarction (0.9% vs 1.3%), uncontrolled unstable angina (11.0% vs 10.6%), and nonfatal stroke (0.7% vs 0.2%) between the 2 groups. However, the incidences of heart failure and coronary spasm were significantly higher in the beta-blocker group than in the calcium antagonist group (4.2% vs 1.1%, p = 0.001; 1.2% vs 0.2%, p = 0.027, respectively). We conclude that the cardiovascular event rate is substantially lower in Japanese post-AMI patients receiving modern therapy than in those reported in the West, and that there are no significant differences in the cardiovascular event rate between the beta-blocker and calcium antagonist groups.