Pharmacological management of left ventricular systolic dysfunction post-MI relies on ACE inhibitors, beta-blockers, and MRAs, with sacubitril-valsartan not yet showing superiority to ACE inhibitors.
What is the current status of pharmacological management for patients with reduced ejection fraction following acute myocardial infarction?
This review reinforces that traditional guideline-directed medical therapies (ACEi, beta-blockers, MRAs) remain the cornerstone of treatment for post-MI LVSD, while the role of newer agents like ARNIs and SGLT2 inhibitors in this specific setting is still evolving.
Heart failure (HF) with reduced ejection fraction is common following acute myocardial infarction (MI), and active medical management can have a profound impact on prognosis. Reviewing relevant clinical trials, we focus on the pharmacological management of left ventricular systolic dysfunction (LVSD) following an acute MI, although there is overlap with the pharmacological management of chronic HF due to reduced ejection fraction. Angiotensin converting enzyme (ACE) inhibitors, beta-blockers, and mineralocorticoid receptor antagonists are the mainstay of medical management in patients with LVSD post MI; there may also be a role for anticoagulation. Sacubitril-valsartan (angiotensin receptor neprilysin inhibitor) has not yet been shown to be superior to an ACE inhibitor in reducing cardiovascular mortality and HF events in patients with LVSD post MI. Large randomised trials evaluating sodium glucose transporter 2 (SGLT-2) inhibitors in LVSD post MI are ongoing.
Abel et al. (Mon,) conducted a review in Left ventricular systolic dysfunction following acute myocardial infarction. Pharmacological management (ACE inhibitors, beta-blockers, MRAs) was evaluated. Pharmacological management of left ventricular systolic dysfunction post-MI relies on ACE inhibitors, beta-blockers, and MRAs, with sacubitril-valsartan not yet showing superiority to ACE inhibitors.