Strategies in the management of acute myocardial infarction

Clinical trials continue to evaluate the pharmacologic management of myocardial infarction for benefits in mortality, degree of infarct artery patency, and frequency of reocclusion. The discovery of thrombus formation in the development of the myocardial infarction renewed interest in thrombolytic therapy. In appropriate candidates, timely administration of thrombolytics after myocardial infarction restores coronary artery patency, reduces myocardial ischemic damage, and improves left ventricular function. Adjunct therapy for thrombolysis typically includes aspirin, heparin, beta-blockers, nitroglycerin, and angiotensin-converting enzyme inhibitors, if not contraindicated. To reduce cardiac risk, postthrombolysis management generally includes aspirin, beta-blockers, and angiotensin-converting enzyme inhibitors together with efforts to reduce known cardiovascular risk factors.