Medical management following myocardial infarction

Medication

Indication

Dual antiplatelet therapy
(low-dose aspirin + P2Y₁₂ inhibitor)

• All patients (regardless of stent placement)
• Low-dose aspirin continued indefinitely
• P2Y₁₂ inhibitor continued for 12 months

Beta blocker
(eg, metoprolol, carvedilol)

• All patients, continued indefinitely
• Reduces myocardial oxygen demand, decreases arrhythmia risk & inhibits remodeling

ACE inhibitor or angiotensin II receptor blocker

• All patients, continued indefinitely for reduced LVEF
• Inhibits post-MI remodeling

High-intensity statin
(eg, atorvastatin, rosuvastatin)

• All patients, continued indefinitely
• Stabilizes atherosclerotic plaque & reduces recurrent MI

Mineralocorticoid antagonist
(eg, spironolactone)

• Reduced LVEF with symptoms or comorbid DM
• Inhibits post-MI remodeling

DM = diabetes mellitus; LVEF = left ventricular ejection fraction; MI = myocardial infarction.