Optimal treatment for patients after myocardial infarction: some current concepts and controversies

Acute coronary syndromes areone of the most common causes for hospitalizations in developed countries. It is estimated that there are around 1 million patients in Poland after myocardial infarction (MI) requiring medical care. Implementation of optimal treatment in these patients is a significant clinical and social problem. Clinical practice guidelines published by the European Society of Cardiology (ESC) are focused on the crucial tasks such as regular physical activity sufficient to increase exercise capacity, smoking cessation, a Mediterranean diet, intensive control of risk factors for atherosclerosis (hypertension, diabetes, hyperlipidemia), combination pharmacotherapy and in selected cases, coronary revascularization. Of particular importance is that all patients who have had an acute MI should receive optimal treatment with a combination of the drugs that are recommended as class I by the ESC guidelines. Recent registries showed that some of these drugs, including aspirin, clopidogrel, angiotensin-converting enzyme inhibitors, β-blockers and statins, are commonly used in clinical practice in Poland. Recently, it has been highlighted that pharmacological therapy in MI patients should be extended by adding newer agents of the class I recommendations such as omega-3 acid ethyl esters and in selected patients, eplerenone.