Routine medical management of acute myocardial infarction. Lessons from overviews of recent randomized controlled trials.
In recent years, several large randomized trials have clarified the role of various interventions in acute myocardial infarction. There is clear evidence that thrombolytic therapy, aspirin, and beta-blockers reduce mortality. Both aspirin and beta-blockers also reduce reinfarction and stroke. Of the thrombolytic agents, comparative trials have established that tissue plasminogen activator and streptokinase have similar effects on mortality, morbidity, and left ventricular function. There appears to be an increased risk of cerebral hemorrhage with tissue plasminogen activator. The benefits of heparin in conjunction with aspirin and a thrombolytic agent are unclear and, at best, are likely to be modest. Heparin increases the risk of hemorrhagic complications twofold. Although trials of vasodilators conducted before the widespread use of thrombolytic therapy and aspirin have been promising, newer trials are needed to evaluate their effects among patients receiving these agents. The aggregate of all trials of the routine use of calcium antagonists or antiarrhythmic agents indicates that these agents do not improve survival.
Yusuf
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S
Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md 20892.
Sleight
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Held
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McMahon
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D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000188:drug therapy*; D009566:Nitrates / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D005343:Fibrinolytic Agents; D009566:Nitrates; D010975:Platelet Aggregation Inhibitors; D008012:Lidocaine; D001241:Aspirin