Secondary prevention after myocardial infarction

Synopsis

Build and monitor the UK post-MI package that reduces recurrent atherothrombotic events, heart failure and preventable treatment harm.

• After MI, the core package is antiplatelet therapy, high-intensity lipid lowering, an ACE inhibitor (or ARB if intolerant), appropriate beta-blockade, lifestyle support and cardiac rehabilitation.
• Aspirin 75 mg daily is normally continued indefinitely; dual antiplatelet therapy is usually continued for up to 12 months, but the chosen P2Y12 inhibitor and duration depend on ACS strategy, bleeding risk and any anticoagulation indication.
• Offer atorvastatin 80 mg unless a lower dose is justified; NICE secondary-prevention targets are LDL cholesterol 2.0 mmol/L or less, or non-HDL cholesterol 2.6 mmol/L or less.
• Start and titrate an ACE inhibitor once clinically and haemodynamically stable; check BP, renal function and electrolytes before treatment and 1–2 weeks after initiation or dose change.
• Early MRA therapy is for recent MI with clinical heart failure plus LV systolic dysfunction, not for every uncomplicated MI.
• Beta-blocker duration is clearest when LV systolic dysfunction or another indication persists; NICE advises discussing stopping after 12 months when LVEF is preserved and there is no other indication.
• Smoking cessation, Mediterranean-style eating, physical activity, weight, BP, diabetes, psychosocial health and medicine adherence are active treatments, not discharge footnotes.