ACC/AHA guidelines for the management of patients with acute myocardial infarction

This community nonrandomized study comprised a consecutive cohort of 1,545 (81% males) ≤65-year-old patients who survived a first acute myocardial infarction (AMI). The all-cause 4- to 5-year mortality rate was 9% (80% cardiac). Univariate analysis revealed that older age, female gender, hypertension, diabetes, not undergoing thrombolysis, higher Killip class, preinfarction heart disease, peripheral vascular disease (PVD) and chronic obstructive lung disease (COLD) were significantly associated with increased mortality. Multivariate analyses disclosed the latter five parameters as being independent predictors of mortality. Our results show that patients undergoing thrombolysis enjoyed a progressive prognostic benefit over time. The independent contribution of PVD and COLD to long-term mortality is highlighted, in addition to the contribution of thrombolytic therapy, Killip class, and heart disease prior to infarction as being important predictors of long-term mortality in patients with a first AMI.

“…Several studies have supported the lack of benefit from thrombolytic therapy in patients older than 65 [15]or 75 years [31, 33]. This could explain the above differences.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Mortality Rates Reflect Progressive Prognostic Benefits of Thrombolysis in Patients with First Acute Myocardial Infarction

Shapira

Pines²,

Goldbourt

et al. 2000

“…β-Blockers have been shown to reduce myocardial oxygen demand, prevent complex ventricular arrhythmias, decrease infarct size, reduce myocardial wall stress, and improve survival [23]. For these reasons, administering β-blockers to patients following MI, both on admission to the emergency department and long term, has become a standard of practice [4]. …”

Section: Benefits Of β-Blockers After MImentioning

confidence: 99%

“…Most patients should receive an aspirin daily, however, some patients with asthma are aspirin sensitive, and this should be taken into consideration [4]. …”

Section: Alternatives To β-Blockers After MI In Patients With Asthmamentioning

confidence: 99%

See 1 more Smart Citation

Beta-Blockers after Myocardial Infarction: Do Benefits Ever Outweigh Risks in Asthma?

Chafin¹,

Soberman

Demirkan³

et al. 1999

β-Blockers are well documented to prolong life in patients after myocardial infarction (MI), yet patients who also have asthma are frequently and understandably denied this therapy. We reviewed the literature (via MEDLINE) for the past 35 years for β-blocker-induced asthma, and reexamined potential β-blocker use in the context of NIH guidelines for asthma classification and management. Because β-blockers can cause fatal or life-threatening asthma, their use should be avoided in moderate to severe persistent asthmatics. Benefits of low-dose β₁-blockers (e.g. atenolol 50 mg daily) may outweigh risks in some patients with mild intermittent or well-controlled mild persistent asthma. Further study is needed to verify that low doses of β₁-blockers are effective in prolonging life after MI, and that use specifically in mild intermittent or mild persistent asthma per NIH classification is safe.

“…Conversely, 2–7% of AMI patients are sent home, thereby placing them at greater risk for AMI complications. Not surprinsingly, undiagnosed AMIs represent the single most common cause of malpractice suits against emergency department physicians today [9, 10, 11, 12]. This impetus implores clinicians and researchers alike to refine existing methdodologies and explore novel techniques when assessing chest pain in patients [13, 14, 15].…”

Section: Introductionmentioning

confidence: 99%

Combining Necrosis and Platelet Markers for Perfecting Myocardial Infarction Rule Out: How Close Are We?

Nair

Gurbel²,

Fuzaylov

et al. 2000

Each year, at least 5 million patients in the United States present to hospital emergency departments with the complaint of chest pain, and more than 10% of them will be diagnosed with acute myocardial infarction. One of the foremost tasks of the emergency department physician is to avoid unnecessary admissions and concomitantly to minimize the number of patients discharged home inappropriately. Currently available diagnostic tools, including the electrocardiogram and myocardial markers, have several shortcomings, including low specificity, and delayed sensitivity for the timely detection of myocardial necrosis. Therefore, the search for better methods of rapidly identifying patients with unstable coronary syndromes is one of the utmost priorities of modern emergency medicine. Available biochemical diagnostic tools are discussed in this review, focusing on the potential benefits of combining myocardial necrosis markers with indicators of platelet activation. It is hypothesized that such a combined approach may be more powerful in myocardial infarction risk stratification than separate marker determination.