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Feature Article

Patients post myocardial infarction: tailored management improves outcomes

Peter L Thompson, Angus G Thompson

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Abstract

Patients who have had a myocardial infarction need aspirin and statin therapy and careful evaluation to identify those who will benefit from revascularisation or implantable device therapy and appropriate additional pharmacological treatment.

Key Points

  • A large evidence base and detailed guidelines are available to help tailor post coronary care management to the individual patient.
  • Definite indications for coronary revascularisation include patients who have had a myocardial infarction (MI) with ongoing symptoms and the presence of a critical coronary stenosis, left main disease or triple vessel coronary artery disease with extensive ischaemia.
  • Although all patients post MI should be given aspirin and statins, the choice and duration of other pharmaceutical therapy is determined by the patients’ symptoms and presence of left ventricular dysfunction.
  • Early implantation of an implantable cardioverter defibrillator does not benefit patients immediately post MI. However, device therapy is indicated in those who had an MI more than 40 days previously and whose ejection fraction is persistently below 35%.

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