Abstract
The management of patients with acute myocardial infarction has changed dramatically in the past decade. These changes have resulted in marked reductions in mortality and improved quality of life. The major advance has been reperfusion therapy with either intravenous thrombolysis or direct percutaneous transluminal coronary angioplasty. Despite the general appreciation of these treatments, they remain underused or are administered in a delayed fashion, resulting in loss of the potential benefit of these powerful therapies. Issues of cost certainly play a role in some jurisdictions regarding the choice of a reperfusion strategy for an individual patient. Many adjunctive treatments have been tested as a means of maximizing the benefit of early reperfusion. Those that are of benefit include aspirin, heparin, β-blockers, and angiotensin-converting enzyme inhibitors. Those of marginal or no benefit include nitrates, magnesium, antiarrhythmic agents, and calcium-channel blockers.
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