Adjunctive pharmacologic therapy for acute myocardial infarction.

Early reperfusion therapy, usually in the form of intravenous thrombolysis, is accepted as the standard therapy for patients with acute myocardial infarction. While thrombolytic therapy has been conclusively shown to reduce mortality, a large percentage of patients are not candidates for this therapy and, even in those who are candidates, as many as 25-30% have persistent occlusion or reocclusion of the infarct-related artery. Adjunctive pharmacologic therapy evolved in an attempt to address these issues and is given in addition to reperfusion therapy. Adjunctive therapy includes administration of one or more of the following: aspirin, heparin, beta-adrenergic blockers, nitroglycerin, heart-rate slowing calcium antagonists, and angiotensin-converting enzyme inhibitors. Data are emerging that indicate that some of these agents provide additional reduction in morbidity and mortality when used as adjunctive strategies. Currently, a recommended combination includes, at minimum, soluble aspirin, intravenous heparin, an intravenous beta-blocking agent, and oral angiotensin-converting enzyme inhibitor.