Jafri S M, Gheorghiade M, Mahdyoon H, Goldstein S
Henry Ford Heart and Vascular Institute, Division of Cardiovascular Medicine Henry Ford Hospital.
Curr Probl Cardiol. 1991 Sep;16(9):585-649. doi: 10.1016/0146-2806(91)90011-x.
Several therapeutic agents have been tested for secondary prevention after acute myocardial infarction. Each patient presents a clinical challenge and gives the physician an opportunity to use the tests and therapy most likely to benefit the clinical course. The presence of other associated medical conditions, the type of myocardial infarction, the presence or absence of accompanying ischemia, left ventricular dysfunction, intracardiac thrombus, or ventricular arrhythmias dictate the choices that are to be made. It is apparent from this review that no single class of agents can be considered a cure, although beta-adrenergic blocking agents come the closest to this role. Analysis of these drugs helps individualize drug therapy and provides a physiologic probe to understanding the pathophysiologic processes that characterize the period after myocardial infarction. To address the impact of developing technology and drug availability on the practice and cost of medical care, the American College of Cardiology and the American Heart Association have developed guidelines for the management of patients with myocardial infarction. The clinical trial remains the best test for the assessment of therapeutic choices and can also expand our knowledge of the natural history of the disease process. Nevertheless, the issue of appropriate therapy is ever-changing, affected by the explosion of new technology and the continued investigation into the pathophysiology of coronary artery disease.
几种治疗药物已在急性心肌梗死后的二级预防中进行了测试。每个患者都带来了临床挑战，也给医生提供了一个机会，去使用最有可能有益于临床病程的检查和治疗方法。其他相关疾病的存在、心肌梗死的类型、是否伴有缺血、左心室功能障碍、心内血栓或室性心律失常决定了需要做出的选择。从这篇综述中可以明显看出，虽然β-肾上腺素能阻滞剂最接近这一作用，但没有哪一类药物可以被视为一种治愈方法。对这些药物的分析有助于实现药物治疗的个体化，并为理解心肌梗死后阶段的病理生理过程提供一个生理学探索手段。为了探讨技术发展和药物可及性对医疗实践和成本的影响，美国心脏病学会和美国心脏协会制定了心肌梗死患者管理指南。临床试验仍然是评估治疗选择的最佳检验方法，也可以扩展我们对疾病自然史的认识。然而，由于新技术的迅猛发展以及对冠状动脉疾病病理生理学的持续研究，恰当治疗的问题一直在变化。
