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

R Weir, J J V McMurray

Department of Cardiology, Western Infirmary, Glasgow, UK

Correspondence to:
Correspondence to:
Professor John J V McMurray
Department of Cardiology, Western Infirmary, Glasgow G12 8QQ, UK; j.mcmurray{at}bio.gla.ac.uk

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.

Abbreviations: ACE, angiotensin converting enzyme; AIRE, acute infarction ramipril efficacy; AMI, acute myocardial infarction; ARB, angiotensin receptor blocker; CAPRICORN, carvedilol post infarct survival control in left ventricular dysfunction; CARE, cholesterol and recurrent events; EPHESUS, eplerenone neurohormonal efficacy and survival study; 4S, Scandinavian simvastatin survival study; LIPID, long-term intervention with pravastatin in ischemic disease; LVSD, left ventricular systolic dysfunction; OPTIMAAL, optimal trial in myocardial infarction with the angiotensin II antagonist losartan; SAVE, survival and ventricular enlargement; TRACE, trandolapril cardiac evaluation study; VALIANT, valsartan in acute myocardial infarction trial

Keywords: angiotensin converting enzyme inhibitors; angiotensin receptor blockers; acute myocardial infarction; ß blockers; eplerenone; heart failure; left ventricular systolic dysfunction

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