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. 2005 May;91(Suppl 2):ii17–ii20. doi: 10.1136/hrt.2005.062042

Treatments that improve outcome in the patient with heart failure, left ventricular systolic dysfunction, or both after acute myocardial infarction

R Weir, J McMurray
PMCID: PMC1876342  PMID: 15831602

Abstract

Patients with heart failure, left ventricular systolic dysfunction, or both, after acute myocardial infarction have a poor prognosis. It is important to focus treatment on this high risk group to reduce the persistently high morbidity and mortality after acute myocardial infarction. As in chronic heart failure, there is now good evidence that inhibition of the renin–angiotensin–aldosterone system and sympathetic nervous system, with the appropriate drugs, can reduce morbidity and mortality. In addition to angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and ß blockers, the aldosterone blocker eplerenone has now been shown to be effective in reducing adverse outcomes.

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Figure 1.

Figure 1

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 Effect of angiotensin converting enzyme (ACE) inhibitors on fatal and non-fatal cardiovascular events in survivors of acute myocardial infarction with left ventricular systolic dysfunction, heart failure, or both after acute myocardial infarction. Adapted from Flather et al.10

Figure 2.

Figure 2

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 Incremental benefit of adding a ß blocker to an ACE inhibitor in survivors of acute myocardial infarction with left ventricular systolic dysfunction, heart failure, or both. One year event rates are shown for SAVE/AIRE/TRACE.

Figure 3.

Figure 3

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 An evidence based algorithm for the early treatment of acute myocardial infarction complicated by left ventricular systolic dysfunction, heart failure, or both.

Figure 4.

Figure 4

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 Incremental benefit of adding an aldosterone blocker to an ACE inhibitor in survivors of acute myocardial infarction with left ventricular systolic dysfunction and acute heart failure. EPHESUS is compared to the subset of CAPRICORN patients in Killip class I or greater at baseline.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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