Secondary Prevention Therapies in Real-World Patients with Myocardial Infarction: Eligibility Based on Randomized Trials Supporting European and American Guidelines

Sodium–glucose cotransporter 2 inhibitors in acute and chronic coronary syndrome with and without heart failure

“…An early use of a therapy in post-MI patients does not always yield the same outcome as a chronic use of the same drug in HF patients. There is a need to further evaluate what was different between those RCTs testing for beta-blockers, angiotensin-converting enzyme inhibitors and mineralocorticoid receptor antagonists 11 and those testing for sacubitril/valsartan and SGLT2i. 3,12 In-depth mechanistic studies are also essential to uncover why SGLT2i positively modify cardiovascular and renal outcomes in some patients, but not others.…”

Mineralocorticoid receptor antagonist indication and underuse in high‐risk post‐myocardial infarction patients

“…1 As a consequence, the use of eplerenone in this setting is recommended by international guidelines. 2,3 Since the publication of EPHESUS in 2001, the treatment of patients with MI changed significantly with the broad implementation of revascularization, and the addition of novel anti-thrombotic agents, lipid-lowering drugs, and revascularization techniques, resulting in lower rates of recurrent ischaemic events and mortality. 4,5 Therefore, improving outcomes in this population on top of contemporary treatment is increasingly more challenging.…”

“…7 The potential reasons for MRA underprescription have been detailed elsewhere, 11 and have been consistently reported in real-world cohorts. 3 In the PARADISE-MI trial, patients were randomized to sacubitril/valsartan or ramipril, and MRA use was left at the discretion of the treating physician. Hence, patients using MRAs had lower left ventricular ejection fraction, more signs of congestion, and worse Killip class, suggesting that doctors prescribed MRAs to 'sicker' patients.…”