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February 8, 1993

Secondary Prevention After Myocardial Infarction: Too Many Choices, Which Ones Work?

Author Affiliations

Division of Cardiology Department of Medicine UCSF Program/VAMC 2615 E Clinton Ave Fresno, CA 93703

Arch Intern Med. 1993;153(3):285-288. doi:10.1001/archinte.1993.00410030005001

MYOCARDIAL INFARCTION (MI) is a major sequela of coronary artery disease and carries an adverse prognosis for life. Each year more than 1 million Americans suffer from MI, and about 70% survive the acute event. The survivors of MI remain at risk for reinfarction and death. The subsequent prognosis of these patients is related to the extent and location of MI, left ventricular dysfunction, arrhythmia, and residual ischemia.

Several large clinical trials have been conducted in an effort to alter the prognosis after MI. These trials have evaluated effects of calcium-channel blockers,1-12β-blockers,13-24 nitrates,25-27 antiplatelet therapy, antiarrhythmic drugs,28-30 risk factor modification,31-35 and myocardial revascularization. Of these, only a few have demonstrated beneficial effects in the period after MI. Actually, some studies1-8,28-30 have shown deleterious effects of treatment used for secondary prevention. The results of the second Secondary Prevention Reinfarction Israel Nifedipine Trial (SPRINT 2)