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    Myocardial Infarction


Myocardial Infarction
– New guidelines on defence against heart attack

Myocardial infarction (MI), commonly known as a heart attack, occurs when blood supply to the heart is cut off. This means that oxygen cannot reach the muscle and parts of it start to die.

MI is included in the umbrella term Cardiovascular Disease (CVD) also including stroke. Shockingly, at this time where great efforts have been made to improve living standards and general health, CVD accounts for 45% of all deaths in Europe and 37% of deaths in the EU. However, these figures differ significantly between countries.

In all but 12 European countries, CVD is the main cause of death in men and the main cause of death in women in all but two. The incidence of CVD in women is greater than that in men with 90% of women having one or more risk factors for CVD. Symptoms of CVD are vastly different between men and women and are often misunderstood. For this reason it is essential to have accurate recommendations that are easy to understand.

Every year, organisations such as the European Society of Cardiology (ESC) release guidelines to inform and educate healthcare providers and those that benefit from treatment about the latest findings. ESC recently released guidelines advising on treatments and protocols to follow in the case of acute MI. A particular treatment that has been recommended is dual antiplatelet therapy (DAPT), although the specific details of this treatment have been contentious. In most initial cases, DAPT consists of a combination of aspirin taken with an antiplatelet, usually clopidogrel, for a month. Maintenance therapy following initial treatment is usually in the form of aspirin plus another antiplatelet, such as prasugrel or ticagrelor, for a year. Discussions surrounding DAPT is not focussed on the specific drug, but more on the length of treatment.

An issue that presented itself is that when DAPT is used over a period of time, the risk of CVD is reduced at the cost of an increased risk of excess bleeding. Time limits are set on DAPT as mentioned previously, but there is still a lot of research to be done to ensure that treatment is as effective as possible without endangering patients. Specific patient sub-groups such as the elderly and those with renal insufficiency are at particular risk. The guidelines advise that special attention should be paid to dose adjustment and pharmacological strategies in these groups but more needs to be known.

As recommended by the ESC, more clinical data needs to be gathered to address important questions such as: what is the optimal duration of maintenance therapy? What is the best combination of antiplatelet or anticoagulation medication? What can be done to address the difference in treatment between men and women?

Until we know more, DAPT up to a year will carry on being the chosen treatment path.

 

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