Aronow W S
Hebrew Hospital Home, Bronx, New York 10475, USA.
J Am Geriatr Soc. 1998 Nov;46(11):1459-68. doi: 10.1111/j.1532-5415.1998.tb06017.x.
To review the management of the older person after myocardial infarction (MI).
A computer-assisted search of the English language literature (MEDLINE database) followed by a manual search of the bibliographies of pertinent articles.
Studies on the management of persons after MI were screened for review. Studies in persons older than 60 years and recent studies were emphasized.
Pertinent data were extracted from the reviewed articles. Emphasis was on studies involving older persons. Relevant articles were reviewed in depth.
Available data about therapy of persons after MI, including control of risk factors, use of aspirin and beta-blockers, and indications for use of angiotensin-converting enzyme inhibitors, long-term anticoagulant therapy, nitrates, calcium channel blockers, hormone replacement therapy, antiarrhythmic drugs, the automatic implantable cardioverter-defibrillator, and revascularization, with emphasis on studies involving older persons, were summarized.
Risk factors for coronary artery disease should be controlled after MI in older persons. A serum low-density lipoprotein (LDL) cholesterol >125 mg/dL after MI should be treated with lipid-lowering drug therapy to decrease the serum LDL cholesterol to <100 mg/dL. Aspirin in a dose of 160 mg to 325 mg daily should be given indefinitely. Indications for long-term anticoagulant therapy with warfarin after MI to maintain an international normalized ratio between 2.0 and 3.0 include secondary prevention of MI in persons unable to tolerate daily aspirin, persistent atrial fibrillation, and left ventricular thrombus. Beta-blockers should be given indefinitely. Angiotensin-converting enzyme inhibitors should be given to persons who have congestive heart failure, an anterior MI, or a left ventricular ejection fraction < or = 40%. Calcium channel blockers should not be used unless there is persistent angina pectoris despite beta-blockers and nitrates. Antiarrhythmic drugs other than beta-blockers should not be used. An automatic implantable cardioverter-defibrillator should be used in persons who have a history of ventricular fibrillation or serious sustained ventricular tachycardia or who are at very high risk for developing sudden cardiac death. Until data from the Heart Estrogen/ Progestin Replacement Study are available, use of an estrogen/progestin regimen is recommended in the treatment of postmenopausal women after MI unless they are at increased risk for developing breast cancer. The two indications for revascularization in older persons after MI are prolongation of life and relief of unacceptable symptoms despite optimal medical management.
回顾心肌梗死（MI）后老年患者的管理。
对英文文献（MEDLINE数据库）进行计算机辅助检索，随后对相关文章的参考文献进行手工检索。
筛选关于MI后患者管理的研究进行综述。重点关注60岁以上人群的研究及近期研究。
从综述文章中提取相关数据。重点是涉及老年患者的研究。对相关文章进行深入审查。
总结了MI后患者治疗的现有数据，包括危险因素的控制、阿司匹林和β受体阻滞剂的使用、血管紧张素转换酶抑制剂的使用指征、长期抗凝治疗、硝酸盐、钙通道阻滞剂、激素替代疗法、抗心律失常药物、自动植入式心脏复律除颤器以及血运重建，重点是涉及老年患者的研究。
老年患者MI后应控制冠状动脉疾病的危险因素。MI后血清低密度脂蛋白（LDL）胆固醇>125mg/dL时，应采用降脂药物治疗，将血清LDL胆固醇降至<100mg/dL。应无限期给予每日剂量为160mg至325mg的阿司匹林。MI后使用华法林进行长期抗凝治疗以维持国际标准化比值在2.0至3.0之间的指征包括无法耐受每日阿司匹林的患者的MI二级预防、持续性心房颤动和左心室血栓形成。应无限期给予β受体阻滞剂。充血性心力衰竭、前壁MI或左心室射血分数≤40%的患者应给予血管紧张素转换酶抑制剂。除非在使用β受体阻滞剂和硝酸盐后仍有持续性心绞痛，否则不应使用钙通道阻滞剂。不应使用除β受体阻滞剂以外的抗心律失常药物。有室颤病史或严重持续性室性心动过速病史或发生心脏性猝死风险极高的患者应使用自动植入式心脏复律除颤器。在获得心脏雌激素/孕激素替代研究的数据之前，对于MI后的绝经后女性，除非她们患乳腺癌的风险增加，否则建议使用雌激素/孕激素方案进行治疗。MI后老年患者血运重建的两个指征是延长生命和在最佳药物治疗后缓解无法接受的症状。
