Cardiovascular · UKMLA & AKT
Secondary prevention after myocardial infarction
A free high-yield preview for the UKMLA Applied Knowledge Test. Below are the key points to recognise secondary prevention after myocardial infarction — the full SA Note notes add investigations, management, complications and 10 practice questions.
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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