Myocardial infarction recurrent

Unlabeled Uses Prevention of myocardial infarction, recurrent cerebral embolism treatment adjunct in transient ischemic attacks... 

Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) have been shown to improve vascular outcomes due to their cholesterol-lowering effects as well as multiple pleiotropic effects. In high-risk populations, statin therapy is known to reduce the risk of vascular events such as myocardial infarction and stroke. A meta-analysis of 10 trials involving 79,494 subjects showed that statin therapy reduced the incidence of stroke by 18%, major coronary events by 27%, and all-cause mortality by 15%. The SPARCL trial recently showed that high-dose HMG-CoA reductase inhibitors prevent recurrent stroke and transient ischemic attacks. ... 

Aspirin decreases the risk of death, recurrent infarction, and stroke following myocardial infarction. Aspirin prescription at hospital discharge is a quality care indicator in MI patients.3 All patients should receive aspirin indefinitely those patients with a contraindication to aspirin should receive clopidogrel.2,3... 

Ventricular tachycardia (VT) is defined by three or more repetitive PVCs occurring at a rate greater than 100 beats/min. It occurs most commonly in acute myocardial infarction (MI) other causes are severe electrolyte abnormalities (e.g., hypokalemia), hypoxemia, and digitalis toxicity. The chronic recurrent form is almost always associated with underlying organic heart disease (e.g., idiopathic dilated cardiomyopathy or remote MI with left ventricular [LV] aneurysm). 

The goals of treatment are to lower total and LDL cholesterol in order to reduce the risk of first or recurrent events such as myocardial infarction, angina, heart failure, ischemic stroke, or other forms of peripheral arterial disease such as carotid stenosis or abdominal aortic aneurysm. 

Ridker PM, Rifai N, Pfeffer M, Sacks F, Lepage S, Braunwald E (2000) Elevation of tumor necrosis factor-alpha and increased risk of recurrent coronary events after myocardial infarction. Circulation 101 2149-2153... 

E. Therapeutic response ReoPro has been studied in placebo-controUed trials that evaluated its effects in patients undergoing percutaneous coronary intervention. The primary end point was the occurrence of any of the following events within 30 days of percutaneous coronary intervention death, myocardial infarction (MI), or the need for urgent intervention for recurrent ischemia. A lower incidence of the primary end point was observed in the ReoPro (bolus plus infusion) arm in all three studies. 

Indication Antiplatelet prophylaxis to reduce risk of recurrent transient ischemic attacks (TIA) and myocardial infarction (Ml)... 

However, in a second study, data on 1857 women from the Coumadin Aspirin Reinfarction Study were used to assess the incidence of cardiac deaths or unstable angina as related to the use of HRT. Of the population studied, 524 (28%) had used HRT at some point and 111 of the latter (21%) had started HRT after suffering a myocardial infarct ( new users ). Women who began HRT after their first myocardial infarct had a significantly higher subsequent incidence of unstable angina than women who had never used hormones (39 versus 20%) however, these new hormone users suffered death or recurrence of myocardial infarct at a much lower rate than never-users (4 versus 15%). These differences are striking. Prior/current users had no excess risk of the composite end-point after... 

Some of the beneficial effects of fish oils after acute myocardial infarction have been attributed to an antidysr-hythmic effect on the heart (5). However, the results of a randomized trial in 200 patients with implantable cardioverter defibrillators are at variance with this the rate of cardioversion was higher in those taking fish oils 1.8 g/day than in a control group who took olive oil (6). The lack of benefit and the suggestion that fish oil supplementation may increase the risk of ventricular tachycardia or ventricular fibrillation in some patients with implantable cardioverter defibrillators can reasonably be interpreted as evidence that the routine use of fish oil supplementation in patients with implantable cardioverter defibrillators and recurrent ventricular dysrhythmias should be avoided. 

Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JD, Cole TG, Brown L, Warnica JW, Arnold JM, Wun CC, Davis BR, Braunwald E. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med 1996 335(14) 1001-9. 

Ischemic heart disease is the leading cause of death in the United States today (American Heart Association, 2001). In 1998, over 450,000 deaths were attributable to ischemic heart disease. This year over 1.1 million citizens will have a new or recurrent myocardial infarction. One of the consequences of non-fatal myocardial infarction is congestive heart failure (CHF), afflicting 22% of men and 46% of women surviving heart attacks over the subsequent five years. Currently, there are over 4.7 million Americans living with CHF, and these patients have a five year mortality of 50%. The mainstay of therapy for ischemic heart disease is revascularization. Nearly 2,000,000 cardiac catheterizations and 553,000 coronary artery bypass surgical procedures are performed annually (American Heart Association, 2001). 

Matetzky S, Shenkman B, Guetta V et al. Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction, Circulation 2004 109 3171-3175. 

Patients with acute coronary syndromes such as acute myocardial infarction and unstable angina remain at risk for recurrent myocardial ischemia despite therapy with antiplatelet agents and heparin. Although first clinical trials indicate a possible use of oral direct TIs for the prevention of cardiovascular events in patients after acute myocardial infarction, the presently available data are still limited and it has not... 

IboleJF etal. Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial. JAMA 2004 291 (5) 565-575. 

PTCA). The primary objective was to evaluate the occurrence of major adverse cardiac events (MACE) [death, recurrent myocardial infarction (Ml), or clinically driven target lesion revascularization] 30 days postprocedure. The secondary objectives were to evaluate the binary restenosis, incidence of (sub)acute stent thrombosis at 30 days follow-up, MACE at 6 and 12 months and the QCA endpoints at 6 months. This study was designed to allow a comparison with the patient population and the results of a larger randomized DISTINCT (BiodivYsio stent in controlled clinical trial) study previously conducted in the U.S. 

Primary endpoint MACE (death, recurrent myocardial infarction or clinically driven target vessel revascularisation) at 30 day follow-up... 

SAVE (86) Acute MI within 3-16 days LVEF < 40% no overt HF 2231 Captoprii. 50-mg/ three times a day vs. placebo 19% Reduction of overall mortality significant reduction of death, hospitalization, and recurrent myocardial infarction... 

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