Contemporary Pharmacotherapy of Myocardial Infarction: Recent Advances, Precision Medicine, and a Clinical Pharmacy Perspective Contemporary Pharmacotherapy of Myocardial Infarction

Background: Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide despite significant advances in cardiovascular prevention and treatment. Contemporary management has evolved beyond conventional pharmacotherapy through the incorporation of novel lipid-lowering agents, anti-inflammatory therapies, precision medicine, and multidisciplinary clinical pharmacy services, all of which contribute to improved patient outcomes.Objectives: This review aims to critically summarize current evidence on guideline-directed pharmacotherapy for myocardial infarction, recent therapeutic advances, precision medicine approaches, and the expanding role of clinical pharmacists in optimizing treatment and secondary prevention.Methods: A narrative review of the literature was conducted using PubMed/MEDLINE, Scopus, Embase, Web of Science, and Google Scholar. Relevant randomized controlled trials, systematic reviews, meta-analyses, observational studies, and contemporary international clinical practice guidelines published in English were evaluated to provide an evidence-based overview of current and emerging pharmacological strategies for myocardial infarction management.Results: Guideline-directed medical therapy, including dual antiplatelet therapy, anticoagulants, beta-blockers, renin–angiotensin–aldosterone system inhibitors, mineralocorticoid receptor antagonists, and high-intensity statins, remains the foundation of myocardial infarction management. Recent therapeutic advances, including PCSK9 inhibitors, inclisiran, bempedoic acid, anti-inflammatory agents, and emerging factor XI/XIa inhibitors, have demonstrated potential to reduce residual cardiovascular risk in selected patients. Precision medicine approaches, particularly CYP2C19 genotype-guided antiplatelet therapy, support individualized treatment selection. Clinical pharmacists play an essential role in medication optimization, medication reconciliation, adverse drug reaction monitoring, pharmacogenomic implementation, patient counseling, medication adherence, and secondary prevention, thereby enhancing medication safety and improving long-term cardiovascular outcomes.Conclusion: The pharmacological management of myocardial infarction continues to evolve through the integration of innovative therapies, precision medicine, and multidisciplinary care. Clinical pharmacists are integral to evidence-based cardiovascular management, contributing to safer medication use, personalized therapeutic decision-making, and improved patient outcomes. Continued research focusing on implementation strategies, pharmacogenomics, digital health technologies, and emerging therapeutics is expected to further optimize myocardial infarction care