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Interventions During and After Acute Myocardial Infarction

  • Section 7: Myocardial Infarction
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Summary

Non-surgical treatment in myocardial infarction both during the acute phase and after recovery is reviewed. There is now considerable evidence that infarct size in man can be reduced by early treatment and that some cases of threatened infarction can be aborted.

β-Blockade, given intravenously within about 6 to 8 hours after the onset of pain, can reduce infarct size and abort some infarctions. So far we have no conclusive data as to whether there is a concomitant reduction in mortality.

Early myocardial revascularisation either by coronary graft, percutaneous angioplasty or intracoronary streptokinase are all promising but so far unproven by adequate clinical trial. Randomised trials suggest that intravenous streptokinase may be effective. Early results of trials of hyaluronidase in man appear promising. The mechanism is not clear but may be by promotion of collateral vessel flow.

β-Blockers may act by a number of mechanisms, namely: reduction of cardiac contractility, heart rate and blood pressure, thus reducing cardiac work and oxygen requirement; prevention of cardiac rupture by the same mechanism; and by an early effect on R-on-T ectopic beats and hence serious ventricular arrhythmia. Calcium channel blockade may also be helpful and there are some early studies which support this. Lowering cardiac work by sodium nitroprusside also reduces infarct size.

Heparin may have a place in the treatment of threatened infarction. After recovery it now appears established that β1-blockade will lower mortality. We do not know how long this effect persists. Other agents are less well established (perhaps because the trials have been too small). Anticoagulants may have a place but their use is not widespread. Antiplatelet agents are also controversial. Studies of dipyridamole and sulphinpyrazone have been suggestive but not conclusive; the studies of aspirin are moderately encouraging when all trials are pooled.

Antiarrhythmic therapy after infarction has been disappointing, with the exception of β-blockade. Perhaps more emphasis should also be put upon changes in lifestyle, notably stopping smoking, reducing fat intake and taking regular exercise.

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  1. Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, England

    Peter Sleight

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Sleight, P. Interventions During and After Acute Myocardial Infarction. Drugs 25 (Suppl 2), 282–294 (1983). https://doi.org/10.2165/00003495-198300252-00088

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