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.
Investigation priorities
Establish baseline and assess response to high-intensity therapy.
Management branches
Any confirmed MI
- Reconcile aspirin plus the indicated P2Y12 inhibitor, recording the intended DAPT end/review date and any anticoagulant interaction.
- Start atorvastatin 80 mg unless a lower intensity is justified, and start ACE inhibition once stable; add beta-blocker when appropriate.
Key medicines
Aspirin75 mg orally once daily long term after the acute loading phase.
TicagrelorAfter a 180 mg loading dose, 90 mg orally twice daily for up to 12 months in ACS when selected; 60 mg twice daily is the separate extended-treatment dose for eligible high-risk patients beyond 1 year.