Medical management after myocardial infarction: an evidence-based perspective.

Abstract

There are a number of effective therapies to consider for the patient after myocardial infarction (MI). Careful patient assessment and individualisation of treatment is required for maximum benefit. Key aspects of assessment include consideration of continuing myocardial ischaemia, evaluation of LV function, review of risk factors and patient circumstances relevant to rehabilitation. Thrombolysis for eligible patients and acute aspirin are of proven benefit and the priority is to minimise delay in treatment. Aspirin is indicated long term for all patients. Beta-blockers, ACE inhibitors and possibly nitrates are also beneficial, but questions remain about optimal timing and combination treatment. Anticoagulants should be considered in selected, high-risk patients. Education-counselling measures should be initiated in hospital and continued with risk-factor modification as part of rehabilitation after discharge. Priority should be given to smoking cessation where applicable, and to reduction of elevated serum cholesterol levels.