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The aim of this study was to determine if earlier administration of oral beta-blocker therapy in patients with acute coronary syndromes (ACSs) is associated with increased short-term survival and improved left ventricular (LV) function. We studied 11,581 patients enrolled in the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry from January 2010 to June 2014. Of these patients, 6,117 were excluded as they received intravenous beta-blockers or remained free of any beta-blocker treatment during hospital stay, 23 with unknown timing of oral beta-blocker administration was unknown and 182 because they had death before oral beta-blockers could be given. The final study population comprised 5,259 patients. The primary outcome was the incidence of in-hospital mortality. The secondary outcome was the incidence of severe LV dysfunction defined as an ejection fraction 24 hours) during hospital stay in the remaining 3,882 patients. Early beta-blocker therapy was significantly associated with reduced in-hospital mortality (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.21 to 0.80) and reduced incidence of severe LV dysfunction (OR 0.57, 95% CI 0.42 to 0.78). Significant mortality benefits with early beta-blocker therapy disappeared when patients with Killip Class III/IV were included as dummy variables. The results were confirmed by propensity score-matched analyses. In conclusion, in patients with ACSs, earlier administration of oral beta-blocker therapy should be a priority with a higher probability of improving LV function and in-hospital survival. Patients presenting with acute pulmonary edema or cardiogenic shock should be excluded from this early treatment regimen.