Treatment After Myocardial Infarction

Persons after myocardial infarction (MI) should have their modifiable coronary artery risk factors intensively treated. Hypertension should be treated with beta blockers and angiotensin-converting enzyme (ACE) inhibitors. The blood pressure should be reduced to <140/90 mmHg and to <130/80 mmHg in persons with diabetes or renal insufficiency. The serum low-density lipoprotein cholesterol should be reduced to <70 mg/dl with statins if necessary. Diabetics should have their hemoglobin A_1c reduced to <7.0%. Aspirin or clopidogrel, beta blockers, and ACE inhibitors should be given indefinitely unless contraindications exist to the use of these drugs. Long-acting nitrates are effective antianginal and antiischemic drugs. Postinfarction patients at very high risk for sudden cardiac death should have an implantable cardioverter-defibrillator. The two indications for coronary revascularization are prolongation of life and relief of unacceptable symptoms despite optimal medical management. Dr. Aronow has no real or apparent conflicts of interest relating to the subject under discussion.