ST elevation myocardial infarction secondary prevention: Difference between revisions
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(/* ACC / AHA Guidelines- Recommendations for Smoking (DO NOT EDIT){{cite journal |author=Antman EM, Hand M, Armstrong PW, et al |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial I...) |
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*Complete cessation, no exposure to environmental [[tobacco]] smoke | *Complete cessation, no exposure to environmental [[tobacco]] smoke | ||
===Class I=== | {|class="wikitable" | ||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Status of [[tobacco]] use should be asked about at every visit. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) <nowiki>"</nowiki> | |||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Every [[tobacco]] user and family members who smoke should be advised to quit at every visit. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | |||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' The [[tobacco]] user’s willingness to quit should be assessed. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | |||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' The [[tobacco]] user should be assisted by [[counseling]] and developing a plan for quitting. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | |||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' Follow-up, referral to special programs, or [[pharmacotherapy]] (including [[nicotine replacement]] and pharmacological treatment) should be arranged. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki> | |||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' Exposure to environmental [[tobacco]] smoke at work and home should be avoided. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki>"</nowiki>|} | |||
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==ACC / AHA Guidelines- Recommendations for Blood Pressure Control (DO NOT EDIT)<ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>== | ==ACC / AHA Guidelines- Recommendations for Blood Pressure Control (DO NOT EDIT)<ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>== | ||
Revision as of 15:18, 5 October 2012
ST Elevation Myocardial Infarction Microchapters |
Differentiating ST elevation myocardial infarction from other Diseases |
Diagnosis |
Treatment |
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Case Studies |
ST elevation myocardial infarction secondary prevention On the Web |
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Directions to Hospitals Treating ST elevation myocardial infarction |
Risk calculators and risk factors for ST elevation myocardial infarction secondary prevention |
For the chapter on Secondary Prevention of Coronary Artery Disease in general, click here.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Patients are usually treated with several long-term medications following a ST elevation myocardial infarction with the goal of preventing secondary cardiovascular events such as further myocardial infarctions, congestive heart failure or cerebrovascular accident (CVA). Unless contraindicated, such medications may include:[1]
- Antiplatelet drug therapy such as aspirin and/or clopidogrel should be continued to reduce the risk of plaque rupture and recurrent myocardial infarction. Aspirin is first-line, owing to its low cost and comparable efficacy, with clopidogrel reserved for patients intolerant of aspirin. The combination of clopidogrel and aspirin may further reduce risk of cardiovascular events, however the risk of hemorrhage is increased.[2]
- Beta blocker therapy such as metoprolol or carvedilol should be commenced.[3] These have been particularly beneficial in high-risk patients such as those with left ventricular dysfunction and/or continuing cardiac ischaemia.[4] β-Blockers decrease mortality and morbidity. They also improve symptoms of cardiac ischemia in NSTEMI.
- ACE inhibitor therapy should be commenced 24–48 hours post-MI in hemodynamically-stable patients, particularly in patients with a history of MI, diabetes mellitus, hypertension, anterior location of infarct (as assessed by ECG), and/or evidence of left ventricular dysfunction. ACE inhibitors reduce mortality, the development of heart failure, and decrease ventricular remodelling post-MI.[5]
- Statin therapy has been shown to reduce mortality and morbidity post-MI.[6][7] The effects of statins may be more than their LDL lowering effects. The general consensus is that statins have plaque stabilization and multiple other ("pleiotropic") effects that may prevent myocardial infarction in addition to their effects on blood lipids.[8] A study by AJC by Herbert D. Aranow, et al. indicates that, for patients who underwent lipid-lowering therapy prior to having an acute myocardial infarction (AMI), infarct size was significantly less than for patients who had not received this earlier treatment. Data from 10,548 patients were collected from both the Global Use of Streptokinase or t-PA for Occluded Coronary Arteries (GUSTO) IIb (n=6,414) and the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Supression Using Integrilin Therapy (PURSUIT) (n=4,134) studies, with infarct size measured by patients' peak creatine kinase (CK) -MB levels. Patients who had lipid-lowering therapy had a median peak CK-MB of 4.2 times the upper limit of normal (ULN) compared to 5.2 times the ULN for those who were not pre-treated (p<0.0001). These results suggest a potential benefit of lipid-lowering therapy for patients at risk for an AMI. Noted limitations of the study include: the observational study design (both the potential effects of confounding variables and the "healthy-user bias" ); the lack of documented information differentiating between statin and nonstatin therapies; and the exclusion from analysis of patients who died during the index hospitalization.
- The aldosterone antagonist agent eplerenone has been shown to further reduce risk of cardiovascular death post-MI in patients with heart failure and left ventricular dysfunction, when used in conjunction with standard therapies above.[9]
- Omega-3 fatty acids, commonly found in fish, have been shown to reduce mortality post-MI.[10] While the mechanism by which these fatty acids decrease mortality is unknown, it has been postulated that the survival benefit is due to electrical stabilization and the prevention of ventricular fibrillation.[11] However, further studies in a high-risk subset have not shown a clear-cut decrease in potentially fatal arrhythmias due to omega-3 fatty acids.[12][13]
- Reducing excess weight and exercising regularly.
- Keeping BP and diabetes under check.
- Following a diet low in cholesterol (<200 mg daily) and saturated fat.
- Increasing HDL- Patients with low HDL [A lipoprotein that transports cholesterol in the blood; composed of a high proportion of protein and relatively little cholesterol] (<35 mg/dl) are encouraged to exercise regularly and to take medications to increase HDL levels.
ACC / AHA Guidelines- Recommendations for Secondary Prevention (DO NOT EDIT)[14]
ACC / AHA Guidelines- Recommendations for Smoking (DO NOT EDIT)[14]
2007 Goal
- Complete cessation, no exposure to environmental tobacco smoke
Class I | |||||||||||||||||||||||||||||||||||||||
"1. Status of tobacco use should be asked about at every visit. (Level of Evidence: B) " | |||||||||||||||||||||||||||||||||||||||
"2. Every tobacco user and family members who smoke should be advised to quit at every visit. (Level of Evidence: B)" | |||||||||||||||||||||||||||||||||||||||
"3. The tobacco user’s willingness to quit should be assessed. (Level of Evidence: B)" | |||||||||||||||||||||||||||||||||||||||
"4. The tobacco user should be assisted by counseling and developing a plan for quitting. (Level of Evidence: B)" | |||||||||||||||||||||||||||||||||||||||
"5. Follow-up, referral to special programs, or pharmacotherapy (including nicotine replacement and pharmacological treatment) should be arranged. (Level of Evidence: B)" | |||||||||||||||||||||||||||||||||||||||
"6. Exposure to environmental tobacco smoke at work and home should be avoided. (Level of Evidence: B)"|}
{{cquote| ACC / AHA Guidelines- Recommendations for Blood Pressure Control (DO NOT EDIT)[14]
ACC / AHA Guidelines- Recommendations for Lipid Management (DO NOT EDIT)[14]
ACC / AHA Guidelines- Recommendations for Physical Activity (DO NOT EDIT)[14]
ACC / AHA Guidelines- Recommendations for Weight Management (DO NOT EDIT)[14]
ACC / AHA Guidelines- Recommendations for Diabetes Management (DO NOT EDIT)[14]
ACC / AHA Guidelines- Recommendations for Antiplatelet Agents/Anticoagulants: Aspirin (DO NOT EDIT)[14]
ACC / AHA Guidelines- Recommendations for Antiplatelet Agents/Anticoagulants: Clopidogrel (DO NOT EDIT)[14]
ACC / AHA Guidelines- Recommendations for Antiplatelet Agents/Anticoagulants: Warfarin (DO NOT EDIT)[14]
ACC / AHA Guidelines- Recommendations for Renin-Angiotensin-Aldosterone System Blockers: ACE Inhibitors (DO NOT EDIT)[14]
ACC / AHA Guidelines- Recommendations for Renin-Angiotensin-Aldosterone System Blockers: Angiotensin Receptor Blockers (DO NOT EDIT)[14]
ACC / AHA Guidelines- Recommendations for Renin-Angiotensin-Aldosterone System Blockers: Aldosterone Blockade (DO NOT EDIT)[14]
ACC / AHA Guidelines- Recommendations for Beta Blockers (DO NOT EDIT)[14]
ACC / AHA Guidelines- Recommendations for Influenza Vaccination (DO NOT EDIT)[14]
See also
Sources
References
External links
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