Long-term Management of Patients After Myocardial Infarctions

The management of patients who present with a myocardial i nfarcti on has altered radi ca lly over the past two decades. The expansion of knowledge relating to the epidemiology of the condition together with a greater understanding of the causes of the early mortality from it have resulted in major changes in the way these pati ents are treated duri ng the acute phase of the illness. The deve 1 opment of 'dedi cated' Coronary Care Units in hospitals and the recogni ti on of the need for ' Mobile Coronary Care Units' in the cOl1Ul1unity have made a major impact upon the early mortality from myocardial infarction. Over the past decade, a great deal of attention has been paid to strategies designed to limit the size of a myocardial infarct. As an extensi on of thi s approach, the 1980' s have seen the evo 1 uti on of techniques for revascularization of ischemic tissue. All these procedures while appearing to hold the promise of reducing the acute mortality from myocardial infarction, create the need for a planned approach to the long term management of these patients. While there are some modest i ndi cati ons that coronary atherosc 1 erosi s coul d be arrested or even reversed, for all practical purposes it remains a chroni c progressi ve di sease.