Contemporary therapy after acute myocardial infarction: Case report

Introduction: Due to recent advances in the implementation of early reperfusion strategies, pharmacological therapy, and the standardization of care, the prognosis of acute myocardial infarction (AMI) has significantly improved over the past several decades. Aim: Through the presentation of a patient with AMI complicated by acute stent thrombosis, this paper discusses the use of various pharmacological agents following myocardial infarction, with a review of the relevant literature, particularly randomized clinical trials and patient registries. Case Report: A 45-year-old female patient was hospitalized due to a high-risk anterior wall NSTEMI. Urgent coronary angiography was performed, followed by primary PCI of the LAD with direct stent implantation. After several hours, stent thrombosis occurred, presenting as an anterior wall STEMI; consequently, repeat PCI was performed with implantation of two additional stents-one proximal and one distal to the initially implanted stent, without the use of intravascular imaging. On the seventh day of hospitalization, echocardiography revealed reduced global systolic function of the left ventricle, with an EF of 36% (Simpson's method), along with multiple regional wall motion abnormalities. Dual antiplatelet therapy with aspirin and ticagrelor was initiated, along with an SGLT2 inhibitor, a beta-blocker, ivabradine, an ACE inhibitor later transitioned to an ARB/neprilysin inhibitor, a mineralocorticoid receptor antagonist, high intensity statin and a GLP-1 receptor antagonist. At 6-month follow-up, control echocardiography demonstrated improved/normalized global LV systolic function, with an LVEF of 61% (Simpson's method), significant reduction in regional wall motion abnormalities, and normal LV diastolic function. The patient completed an inpatient cardiovascular rehabilitation programme, continued all prescribed therapies except for the GLP-1 receptor antagonist due to intolerance, and, with excellent effort tolerance, returned to her pre-infarction occupation. Conclusion: Despite the availability of guidelines for the management of patients after AMI, these patients should be approached as a continuum of myocardial injury rather than a homogeneous group. Antiplatelet therapy, lipid-lowering treatment with intensive LDL cholesterol reduction, and early revascularization have consistently been shown to improve long-term outcomes across all patient groups. The effectiveness of other therapeutic agents depends on specific clinical circumstances.