**Core Concept:** Secondary prevention of myocardial infarction (MI) refers to the measures taken to reduce further complications and mortality in patients who have already experienced a myocardial infarction. These measures include pharmacological interventions and lifestyle modifications.

**Why the Correct Answer is Right:**
Correct Answer: D (Ibuprofen)

Ibuprofen is a non-selective COX inhibitor, which blocks the production of prostaglandins. In secondary prevention of MI, COX inhibitors are typically avoided due to their potential for worsening ischemic heart disease and increasing the risk of reinfarction.

**Why Each Wrong Option is Incorrect:**
A. Aspirin - A selective COX-1 inhibitor, aspirin is commonly used in secondary prevention of MI as it has a low risk of gastrointestinal bleeding compared to non-selective COX inhibitors like ibuprofen.

B. Beta-blockers - These are used to reduce heart rate, blood pressure, and myocardial oxygen demand, thereby protecting the heart muscle and reducing mortality in MI patients.

C. Statins - Statins are lipid-lowering medications that help in reducing cardiovascular events and mortality in MI patients by lowering cholesterol levels and improving endothelial function.

D. Ibuprofen - As explained above, ibuprofen is a non-selective COX inhibitor that increases the risk of reinfarction and worsening ischemic heart disease, making it unsuitable for secondary prevention of MI.

E. Beta-blockers - In contrast to option B, beta-blockers are beneficial in MI patients, as mentioned above.

**Clinical Pearl / High-Yield Fact:**

High-Yield Fact: Selective COX-1 inhibitors like aspirin are preferred over non-selective COX inhibitors (like ibuprofen) in secondary prevention of MI, as they have lower risk of gastrointestinal bleeding.

**Explanation of the Question:**

The question is asking which medication among the given options should not be used in the secondary prevention of MI. Non-selective COX inhibitors, like ibuprofen, have a higher risk of gastrointestinal bleeding compared to selective COX-1 inhibitors like aspirin. Aspirin is the correct answer because it is a selective COX-1 inhibitor with a lower risk of gastrointestinal bleeding, making it a preferable choice for secondary prevention of MI compared to ibuprofen.