Established and Emerging Pharmacological Therapies for Post-Myocardial Infarction Patients with Heart Failure: a Review
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REVIEW ARTICLE
Established and Emerging Pharmacological Therapies for Post-Myocardial Infarction Patients with Heart Failure: a Review of the Evidence Leonardo De Luca 1 Accepted: 12 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract After an episode of myocardial infarction (MI), patients remain at risk for recurrent ischemic events, heart failure (HF), and sudden death. Post-MI patients with left ventricular systolic dysfunction (LVSD) have an even greater risk of mortality and morbidity. Randomized clinical trials that included post-MI patients with LVSD have demonstrated that pharmacologic therapies aimed at preventing post-MI remodeling with neurohormonal antagonists can significantly improve short- and long-term outcomes, including death, reinfarction, and worsening HF. Recent trials have also demonstrated benefits in terms of cardiovascular event reduction with effective antithrombotic therapies and cholesterol-lowering agents in post-MI setting, especially in patients at very high risk such as those with LVSD. This paper reviews clinical trials that included post-MI patients with LVSD, with or without signs and symptoms of HF, assessing the efficacy of established and emerging pharmacological therapies. Keywords Myocardial infarction . Heart failure . Pharmacologic therapy
Introduction Heart failure (HF) is a common complication in patients with acute myocardial infarction (MI), ranging from 15% to 35% of cases [1]. Although myocardial revascularization with percutaneous coronary intervention (PCI) has been demonstrated to significantly decrease cardiovascular (CV) events and left ventricular (LV) remodeling in post-MI patients, the incidence of HF remains high after an MI episode and will likely continue to play a major role in the future regarding health care resources and individual morbidity and mortality [1–10]. The presence of left ventricular systolic dysfunction (LVSD) is associated with adverse outcomes and reduced survival rates after the index MI, and a low left ventricular ejection fraction (LVEF) still remains the most powerful independent predictor of sudden arrhythmic death in post-MI patients [11–16]. Over the past decades, several clinical trials have shown that secondary prevention pharmacological strategies
significantly reduce the relative risk of post-MI mortality by more than 60% by: (1) blocking neurohormonal activity responsible for worsening LVSD, (2) reducing cholesterol levels involved in plaque progression and instability, and (3) inhibiting platelet activation that can cause recurrent ischemia and infarction (Table 1). International guidelines strongly recommend the use of neurohormonal blocking agents in HF patients [2, 3] and suggest prescribing antiplatelets and cholesterol-lowering agents in post-MI cases in order to prevent recurrent ischemic events and promote plaque stabilization [4–7] (Fig. 1). This review summarizes the clinical trial data of established pharmacologic interventions in MI survivors with LVSD and review the results
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