February 8, 1993
View Full PaperSecondary Prevention After Myocardial Infarction
Structured PICO
Do secondary prevention therapies reduce reinfarction and death in survivors of myocardial infarction?
P
Population
Survivors of myocardial infarction
I
Intervention
Secondary prevention therapies including calcium-channel blockers, beta-blockers, nitrates, antiplatelet therapy, antiarrhythmic drugs, risk factor modification, and myocardial revascularization
O
Outcome
Reinfarction and deathhard clinical
A review of secondary prevention trials after MI indicates that while some therapies are beneficial, others may have deleterious effects.
Abstract
MYOCARDIAL INFARCTION (MI) is a major sequela of coronary artery disease and carries an adverse prognosis for life. Each year more than 1 million Americans suffer from MI, and about 70% survive the acute event. The survivors of MI remain at risk for reinfarction and death. The subsequent prognosis of these patients is related to the extent and location of MI, left ventricular dysfunction, arrhythmia, and residual ischemia. Several large clinical trials have been conducted in an effort to alter the prognosis after MI. These trials have evaluated effects of calcium-channel blockers,1-12β-blockers,13-24nitrates,25-27antiplatelet therapy, antiarrhythmic drugs,28-30risk factor modification,31-35and myocardial revascularization. Of these, only a few have demonstrated beneficial effects in the period after MI. Actually, some studies1-8,28-30have shown deleterious effects of treatment used for secondary prevention. The results of the second Secondary Prevention Reinfarction Israel Nifedipine Trial (SPRINT 2)