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Medikamentöse Therapie zur Prognoseverbesserung nach akutem Myokardinfarkt

Therapeutic strategies for improvement of survival after myocardial infarction

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Zusammenfassung

Die nach der akuten Therapie des Myokardinfarkts beginnende chronische Therapie ist von großer Bedeutung für die Lebensqualität und Prognose der erkrankten Patienten. Frühere Untersuchungen zeigten, daß in den westlichen, industrialisierten Ländern selbst lange etablierte Therapieprinzipien noch nicht bei allen Patienten eingesetzt werden.

In dieser Übersichtsarbeit sind die heute bewiesenen Therapiestrategien zusammen mit den größten relevanten klinischen Studien dargestellt. Die wichtigsten Bausteine der langfristigen Infarkttherapie sind die adrenergen Betarezeptorenblocker, die ACE-Hemmer, die Thrombozytenaggregationshemmer sowie die Lipidsenker. Das Ausmaß der Verbesserung der Überlebenszeit mit diesen Substanzen wird anhand der Diskussion der zugrundeliegenden Studien dargestellt. Weitere medikamentöse, noch nicht bewiesene Ansätze, wie die Angiotensinrezeptorblocker (AT1-Antagonisten) und antioxidative Substanzen, werden diskutiert.

Abstract

This review article summarizes the long-term standard therapy for patients with myocardial infarction. The chronic therapy is able to significantly improve quality of life and survival of affected patients. Previous studies showed that in most western countries, the established standard therapy is not given to all patients who would benefit from chronic treatment.

The essential parts of today’s myocardial infarction treatment consists of effective beta-blockade, inhibition of the angiotensin-conversion enzyme, inhibition of platelet aggregation and lipid lowering agents. This article reviews the clinical benefits which may be expected from each of these therapeutic approaches. Newer, but not yet proven strategies, like blockade of the angiotensin receptor subtype 1 and treatment with antioxidative agents will be discussed.

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Literatur

  1. Ambrosioni E, Borghi C, Magnani B. The effect of the angiotensin-converting-enzyme inhibitor zofenopril on mortality and morbidity after anterior myocardial infarction. N Engl. J Med 1995; 332: 80–5.

    Article  PubMed  CAS  Google Scholar 

  2. Becker RC. Antiplatelet therapy in coronary heart disease. Emerging strategies for the treatment and prevention of acute myocardial infarction. Arch Pathol Lab Med 1993; 117: 89–96.

    PubMed  CAS  Google Scholar 

  3. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996; 348: 1329–39.

    Article  Google Scholar 

  4. Chinese Cardiac Study Collaborative Group. Oral captopril versus placebo among 13634 patients with suspected acute myocardial infarction: interim report from the Chinese Cardiac Study (CCS-1). Lancet 1995; 345: 686–7.

    Google Scholar 

  5. Cooke AR, Goulston K. Failure of intravenous aspirin to increase gastrointestinal blood loss. Br Med J 1969; 3: 330–2.

    Article  PubMed  CAS  Google Scholar 

  6. Fuster V, Dyken ML, Vokonas PS, et al. Aspirin as a therapeutic agent in cardiovascular disease. Circulation 1993; 87: 659–75.

    PubMed  CAS  Google Scholar 

  7. Gaspari F, Vigano G, Orisio S, et al. Aspirin prolongs bleeding time in uremia by a mechanism distinct from platelet cyclooxygenase inhibition. J Clin Invest 1987; 79: 1788–97.

    Article  PubMed  CAS  Google Scholar 

  8. Gaziano JM, Buring JE, Breslow JL, et al. Moderate alcohol intake, increased levels of high-density lipoprotein and its subfractions, and decreased risk of myocardial infarction. N Engl J Med 1993; 329: 1829–34.

    Article  PubMed  CAS  Google Scholar 

  9. Gruppo Italiano per lo Studio della Sopravivenza nell’Infarto Miocardico. GISSI-3: effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarction. Lancet 1994; 343: 1115–22.

    Google Scholar 

  10. Hanson SR, Harker LA, Bjornsson TD. Effects of plateletmodifying drugs on arterial thromboembolism in baboons. Aspirin potentiates the antithrombotic actions of dipyridamole and sulfinpyrazone by mechanism(s) independent of platelet cyclooxygenase inhibition. J Clin Invest 1985; 75: 1591–9.

    Article  PubMed  CAS  Google Scholar 

  11. Hjalmarson A, Elmfeldt D, Herlitz J, et al. Effect on mortality of metoprolol in acute myocardial infarction. A double-blind randomised trial. Lancet 1981; 2 (8251): 823–9.

    Article  PubMed  CAS  Google Scholar 

  12. ISIS-1 (First International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous atenolol among 16027 cases of suspected acute myocardial infarction: ISIS-1. Lancet 1986; 2 (8498): 57–66.

    Google Scholar 

  13. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17 187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988; 2 (8607): 349–60.

    Google Scholar 

  14. ISIS-4 (Fourth International Study of Infarct Survival) Collaborative Group. ISIS-4: A randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58 050 patients with suspected acute myocardial infarction. Lancet 1995; 345: 669–685.

    Article  Google Scholar 

  15. Johnston CI. Renin-angiotensin system: a dual tissue and hormonal system for cardiovascular control. Hypertension 1992; 10: S13–26.

    Article  Google Scholar 

  16. Juul-Möller S, Edvardsson N, Rosen A, et al. Double-blind trial of aspirin in primary prevention of myocardial infarction in patients with stable chronic angina pectoris. Lancet 1992; 340: 1421–5.

    Article  PubMed  Google Scholar 

  17. Kober I, Torp-Pedersen C, Carlsen JE, et al. A clinical trial of the angiotensin — converting — enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 1995; 333: 1670–6.

    Article  PubMed  CAS  Google Scholar 

  18. Latini R, Maggioni AP, Flather M, et al. ACE inhibitor use in patients with myocardial infarction. Summary of evidence from clinical trials. Circulation 1995; 92: 3132–7.

    PubMed  CAS  Google Scholar 

  19. Leaf A, Jorgensen MB, Jacobs AK, et al. Do fish oils prevent restenosis after coronary angioplasty? Circulation 1994; 90: 2248–57.

    PubMed  CAS  Google Scholar 

  20. Lengfelder W. Antioxidative Vitamine: Prävention von kardiovaskulären Erkrankungen. Dtsch Med Wochenschr 1998; 123: 1014–7.

    Article  PubMed  CAS  Google Scholar 

  21. Losonczy KG, Harris TB, Havlik RJ. Vitamin E and vitamin C supplement use and risk of all-cause and coronary heart disease mortality in older persons: the established populations for epidemiologic studies of the elderly. Am J Clin Nutr 1996; 64: 190–6.

    PubMed  CAS  Google Scholar 

  22. Malmberg K, Herlitz J, Hjalmarson A, et al. Effects of metoproloi on mortality and late infarction in diabetics with suspected acute myocardial infarction. Eur Heart J 1989; 10: 423–8.

    PubMed  CAS  Google Scholar 

  23. Pedersen TR. Six-year follow-up of the norwegian multicenter study on timolol after acute myocardial infarction. N Engl J Med 1985; 313: 1055–8.

    PubMed  CAS  Google Scholar 

  24. Pekkanen J, Linn S, Heiss G, et al. Ten-Year mortality from cardiovascular disease in relation to cholesterol level among men with and without preexisting cardiovascular disease. N Engl J Med 1990; 322: 1700–7.

    PubMed  CAS  Google Scholar 

  25. Pfeffer MA, Braunwald E, Moye LA, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the Survival and Ventricular Enlargement Trial. N Engl J Med 1992; 327: 669–77.

    PubMed  CAS  Google Scholar 

  26. Rimm EB, Stampfer MJ, Ascherio A, et al. Vitamin E consumption and the risk of coronary heart disease in men. N Engl J Med 1993;328: 1450–6.

    Article  PubMed  CAS  Google Scholar 

  27. Roux S, Christeiler S, Ludin E. Effects of aspirin on coronary reocclusion and recurrent ischemia after thrombolysis: A metaanalysis. J Am Coll Cardiol 1992; 19: 671–7.

    Article  PubMed  CAS  Google Scholar 

  28. Ruotolo G, Ericsson C-G, Tettamanti C, et al. Treatment effects on serum lipoprotein lipids, apolipoproteins and low density lipoprotein protein particle size and relationships of lipoprotein variables to progression of coronary artery disease in the Bezafibrate Coronary Atherosclerosis Intervention Trial (BECAIT). J Am Coll Cardiol 1998; 32: 1648–56.

    Article  PubMed  CAS  Google Scholar 

  29. Ryan TJ, Anderson JL, Antman EM, et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction. J Am Coll Cardiol 1996; 28: 1328–419.

    Article  PubMed  CAS  Google Scholar 

  30. Sacks FM, Moye L, Davis BR, et al. Relationship between plasma LDL concentrations during treatment with pravastatin and recurrent coronary events in the Cholesterol and Recurrent Events Trial. Circulation 1998; 97: 1446–52.

    PubMed  CAS  Google Scholar 

  31. Sagiv M, Goldbourt U. Influence of physical work on high density lipoprotein cholesterol: implications for the risk of coronary heart disease. Int J Sports Med 1994; 15: 261–6.

    Article  PubMed  CAS  Google Scholar 

  32. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383–9.

    Google Scholar 

  33. Stampfer MJ, Hennekens CH, Manson JE, et al. Vitamin E consumption and the risk of coronary disease in women. N Engl J Med 1993; 328: 1444–9.

    Article  PubMed  CAS  Google Scholar 

  34. Stephens NG, Parsons A, Schofield PM, et al. Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet 1996; 347: 781–6.

    Article  PubMed  CAS  Google Scholar 

  35. Swedberg K, Held P, Kjekshus J, et al. Effects of the early administration of enalapril on mortality in patients with acute myocardial infarction. Results of the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II). N Engl J Med 1992; 327: 678–84.

    PubMed  CAS  Google Scholar 

  36. ß-Blocker Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardial infarction I. Mortality results. JAMA 1982; 247: 1707–14.

    Article  Google Scholar 

  37. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993; 342: 821–8.

    Google Scholar 

  38. The Consensus Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. N Engl J Med 1987; 316: 1429–35.

    Google Scholar 

  39. The Long-Term Intervention with Pravastatin in Ischaemic Desease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349–57.

    Article  Google Scholar 

  40. The MIAMI Trial Research Group. Metoprolol in acute myocardial infarction. Arrhythmias. Am J Cardiol 1985; 56: 35G-8G.

    Article  Google Scholar 

  41. The MIAMI Trial Research Group. Metoprolol in acute myocardial infarction. Mortality. Am J Cardiol 1985; 56: 15G-22G.

    Article  Google Scholar 

  42. The Multicenter Postinfarction Research Group. Risk stratification and survival after myocardial infarction. N Engl J Med 1983; 309: 331–6.

    Google Scholar 

  43. The Norwegian Multicenter Study Group. Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med 1981; 304: 801–7.

    Google Scholar 

  44. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991; 325: 293–302.

    Google Scholar 

  45. The TIMI Study Group. Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction. N Engl J Med 1989; 320: 618–27.

    Google Scholar 

  46. West of Scotland Coronary Prevention Study Group. Influence of pravastatin and plasma lipids on clinical events in the West of Scotland Coronary Prevention Study (WOSCOPS). Circulation 1998; 97: 1440–5.

    Google Scholar 

  47. White HD, Norris RM, Brown MA, et al. Left ventricular endsystolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation 1987; 76: 44–51.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Franz-Volhard-Klinik am Max-Delbrück-Centrum für Molekulare Medizin, Universitätsklinik Charité, Humboldt-Universität Berlin, Wilthergstraße 50, D-13125, Berlin

    Roland Willenbrock & Rainer Dietz

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  1. Roland Willenbrock
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  2. Jan Monti
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  3. Rainer Dietz
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Correspondence to Roland Willenbrock.

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Willenbrock, R., Monti, J. & Dietz, R. Medikamentöse Therapie zur Prognoseverbesserung nach akutem Myokardinfarkt. Herz 24, 389–397 (1999). https://doi.org/10.1007/BF03043930

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