[Integration of therapeutic options and the candidates for treatment: the ABC of the post-infarction period].
Acute myocardial infarction, major cause of death in Western society, has been the focus of many clinical investigations over the past decade. As the result of randomized trials involving hundreds of thousands of infarct patients worldwide, the life-saving potential of several pharmacologic interventions has been validated, and the usefulness of other commonly used treatments has been disproven or brought into question. Much of the innovative therapy has been targeted toward limiting myocardial damage by eradicating the occlusive thrombus or otherwise restoring flow through the infarct-related artery, reducing oxygen demands in the injured ventricle, and altering vascular dynamics to limit the process of ventricular remodeling. Data have accumulated showing substantially lower mortality of acute myocardial infarction with simple pharmacological interventions such as intravenous thrombolytic therapy, aspirin, beta-blockers and ACE-inhibitors. In particular, ACE-inhibitors have recently proven to be effective in infarcted patients, especially in high-risk subjects with acute anterior infarction not treated with thrombolytic agents or patients with left ventricular dysfunction. ACE-inhibitors may limit the process of ventricular remodeling after a large infarction, lessening the risk of sudden death and heart failure. Intravenous heparin has a role in maintaining patency of infarct-related vessel after rt-PA, and it seems that this combination offers some benefits with respect to streptokinase plus subcutaneous heparin. Recent studies have also demonstrated the importance of lipid-lowering agents for secondary prevention after myocardial infarction. Several previously recommended therapies (routine intravenous lidocaine, calcium channel blockers, magnesium, nitrates) have not been proven to be life-saving.
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Clinica Medica III, Università degli Studi di Bologna.
Bacchelli
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Borghi
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D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy*; D018579:Patient Selection; D015912:Thrombolytic Therapy
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000924:Anticholesteremic Agents; D000925:Anticoagulants