Pharmacological treatment for myocardial infarction. Part 1: Implications of clinical trials of thrombolytic and antithrombotic therapies

Aim. To summarize the pharmacological interventions in myocardial infarction. Part one of the series concentrates on thrombolytic and antithrombotic therapies. Part two concentrates on other adjunctiye therapies in myocardial infarction. Methods. A review of the results of randomly allocated clinical trials and meta-analyses of treatments for myocardial infarction. Results. Large randomized trials have demonstrated that thrombolytic therapy can reduce mortality in patients with acute myocardial infarction (AMI), with net benefit for those presenting upto at least 12 hours after symptom onset. Irrespective of which agent is used, patients must receive this therapy as soon as possible. Large randomized trials have clarified the role of various other pharmacological interventions in myocardial infarction. There is clear and reliable evidence that aspirin, beta-blockers, and angiotensin converting enzyme inhibitors reduce mortality. Magnesium, calcium channel blockers or class I antiarrhythmic agents have not been demonstrated to be beneficial. The latter two may even be harmful. There is no clear evidence till date of overall benefit or harm with the routine use of nitrates or heparin (although these agents are widely used clinically).