Cardiology>>>>>Ischaemic heart disease
Question 113#

A 60-year-old woman was discharged after an MI. Pharmacologic secondary prevention with antiplatelet agents, statins, β-blockers, and angiotensinconverting enzyme inhibitors is associated with:

A. Significant reduction in recurrent angina but no mortality benefit
B. Significant survival advantage
C. No significant clinical benefit
D. Significant reduction in recurrent hospitalization but no mortality benefit
E. Significant survival advantage only in patients treated with PCI

Correct Answer is B

Comment:

Significant survival advantage. A cohort study of approximately 1,400 patients demonstrated that the use of combination evidence-based medical therapies was independently and strongly associated with lower 6-month mortality in patients with ACSs. Furthermore, there was a gradient of benefit across the different TIMI risk groups with higher-risk patients obtaining higher absolute benefit. The 2013 AHA/ACCA STEMI guidelines recommend:

1. Indefinitely aspirin 81 to 325 mg daily maintenance dose after PCI (class I).
2. β-blockers should be continued after hospitalization for all patients with STEMI and with no contraindications to their use (class I).
3. Angiotensin-converting enzyme inhibitors are reasonable for all patients with STEMI and no contraindications to their use (class IIa and class I if presence of reduced LVEF).
4. High-intensity statin therapy should be initiated or continued in all patients with STEMI and no contraindications to its use.