Advances in the treatment of the acute phase of
myocardial infarction have lead to the need for adequate secondary treatment. beta-blockers have been largely demonstrated to be effective antianginal agents, acting on three determining factors: heart rate, systemic blood pressure and myocardial contractility. Used in secondary prevent treatment, beta-blockers lead to significant improvement in global post-
myocardial infarction mortality, reduced from 9.4 to 7.6% and in reinfarction rates, reduced from 7.5 to 5.6%. Prescription of beta-blockers beyond the acute phase is an essential part of
secondary prevention. For
calcium antagonists however, there is no evidence of improved prognosis after
myocardial infarction. There is no improvement in mortality or reinfarction rates. Class I
antiarrhythmic drugs are not indicated as systematic treatment after
myocardial infarction.
Angiotensin converting enzyme inhibitors can reduce long-term mortality and late occurrence of
congestive heart failure, particularly in patients with moderate to severe
left ventricular dysfunction. Among the anti-thrombotic drugs, oral
anticoagulants seem to offer no clear advantage over
aspirin. Large trials of
anti-arrhythmic agents have failed to demonstrate any clinical benefit in asymptomatic patients with
ventricular ectopic beats, and the results of
secondary prevention trials using
amiodarone are still awaited.
Myocardial revascularization using coronary bypass surgery or percutaneous transluminal coronary angioplasty should be proposed mainly in symptomatic patients or in subsets of patients with multi-vessel disease and altered left ventricular function. Finally, rehabilitation measures should be aimed at correcting cardiovascular risk factors and improving physical fitness.