Cardiovascular · UKMLA & AKT
Secondary prevention after myocardial infarction
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- Five pharmacological pillars initiated in hospital and continued long-term post-MI, unless contraindicated.
- Antiplatelet (DAPT): aspirin 75 mg OD indefinitely + ticagrelor 90 mg BD (preferred) or clopidogrel 75 mg OD for 12 months
- After 12 months step down to aspirin monotherapy; patients with drug-eluting stent must complete full 12-month DAPT course
- High ischaemic / low bleeding risk: consider extended DAPT or rivaroxaban 2.5 mg BD added to aspirin
- Statin: atorvastatin 80 mg OD - start in hospital regardless of baseline LDL; continue indefinitely
- Target LDL <1.8 mmol/L (or >50% reduction) and non-HDL <2.5 mmol/L at 3 months
- ACE inhibitor: ramipril - within 24-48 hours of MI; reduces remodelling, mortality, and reinfarction; especially important if LVEF reduced, heart failure, hypertension, or diabetes
- Beta-blocker: bisoprolol or carvedilol - reduces heart rate, oxygen demand, arrhythmia risk, and sudden cardiac death; continue indefinitely if LVEF ≤40% or heart failure with reduced EF
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