Drug therapy for prevention of recurrent myocardial infarction.
OBJECTIVE
To provide an evidence-based overview of drug treatment for long-term secondary prevention of myocardial infarction (MI).


METHODS
We conducted searches of MEDLINE (1966-August 2002), the Cochrane Controlled Trial Register, and the reference list of each identified study.


METHODS
Trials and meta-analyses were included using the following criteria: (1) randomized trials, (2) description of identification procedure, inclusion criteria, outcome measures, and statistical methods, (3) confirmed MIs, (4) treatment continued for at least 1 month, and (5) all-cause mortality as primary outcome; other events as secondary outcomes. All authors interpreted the results from trials that met the inclusion criteria.


RESULTS
In randomized clinical trials, low-dose aspirin, high-intensity oral anticoagulants, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and statins decreased the risk of mortality and reinfarction after MI. Randomized clinical trials using calcium-channel blockers, antiarrhythmics, and hormone replacement therapy did not show benefits in patients with prior MI. Effects of the combined use of aspirin or oral anticoagulants with beta-blockers or ACE inhibitors plus statins must be derived from subgroup analysis of trials, but seem to be beneficial.


CONCLUSIONS
The use of at least aspirin or an oral anticoagulant, a beta-blocker or an ACE inhibitor, plus a statin should be incorporated in the treatment routine. Clopidogrel treatment might be an alternative to aspirin. Standard addition of a beta-blocker to ACE inhibitor-treated patients without reduced left-ventricular ejection fraction seems to be untimely.
D019317:Evidence-Based Medicine; D006801:Humans; D015201:Meta-Analysis as Topic; D009017:Morbidity; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control*; D055502:Secondary Prevention