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[Treatment after myocardial infarction]
1Service de Cardiologie A, Hôpitaux de Brabois, CHU de Nancy, Vandoeuvre.
Insights
Beta-blockers significantly improve survival and reduce reinfarction rates after myocardial infarction, making them essential for secondary prevention. Other treatments like calcium antagonists and antiarrhythmics show no proven benefit for post-myocardial infarction prognosis.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Myocardial infarction (MI) treatment advances necessitate effective secondary prevention strategies.
- Beta-blockers are established antianginal agents impacting heart rate, blood pressure, and contractility.
Purpose:
- To review the efficacy of various pharmacological and interventional treatments for secondary prevention after myocardial infarction.
- To evaluate the impact of these treatments on mortality and reinfarction rates.
Summary:
- Beta-blockers significantly reduce post-MI mortality (9.4% to 7.6%) and reinfarction rates (7.5% to 5.6%), proving essential for secondary prevention.
- Calcium antagonists and Class I antiarrhythmics lack evidence for improved prognosis post-MI.
- Angiotensin-converting enzyme inhibitors benefit select patients with heart failure, while aspirin is favored over oral anticoagulants.
- Revascularization is indicated for symptomatic patients or those with specific risk factors; rehabilitation addresses modifiable risks.
Impact:
- Highlights the critical role of beta-blockers in reducing cardiovascular events post-MI.
- Provides guidance on appropriate secondary prevention strategies, emphasizing evidence-based treatments.
- Underscores the need for individualized treatment plans based on patient symptoms and cardiac function.
Abstract:
Advances in the treatment of the acute phase of myocardial infarction have lead to the need for adequate secondary treatment. beta-blockers have been largely demonstrated to be effective antianginal agents, acting on three determining factors: heart rate, systemic blood pressure and myocardial contractility. Used in secondary prevent treatment, beta-blockers lead to significant improvement in global post-myocardial infarction mortality, reduced from 9.4 to 7.6% and in reinfarction rates, reduced from 7.5 to 5.6%. Prescription of beta-blockers beyond the acute phase is an essential part of secondary prevention. For calcium antagonists however, there is no evidence of improved prognosis after myocardial infarction. There is no improvement in mortality or reinfarction rates. Class I antiarrhythmic drugs are not indicated as systematic treatment after myocardial infarction. Angiotensin converting enzyme inhibitors can reduce long-term mortality and late occurrence of congestive heart failure, particularly in patients with moderate to severe left ventricular dysfunction. Among the anti-thrombotic drugs, oral anticoagulants seem to offer no clear advantage over aspirin. Large trials of anti-arrhythmic agents have failed to demonstrate any clinical benefit in asymptomatic patients with ventricular ectopic beats, and the results of secondary prevention trials using amiodarone are still awaited. Myocardial revascularization using coronary bypass surgery or percutaneous transluminal coronary angioplasty should be proposed mainly in symptomatic patients or in subsets of patients with multi-vessel disease and altered left ventricular function. Finally, rehabilitation measures should be aimed at correcting cardiovascular risk factors and improving physical fitness.