Long time treatment for patient with STEMI at their discharge from hospital

Introduction: Due to the importance and higher prevalence and incidence rates and also considering the complications of STEMI, the long term medical therapy is important in these patients in order to decrease the mortality and morbidity caused by this disease. Post hospital system of care designed to reduce hospital readmissions should be used to facilitate coordinated.Lifestyle interventions and risk factor control include:1. Cessation of smoking2. Diet (similar to the Mediterranean)3. Avoided alcohol intake 4. Weight loss5. Exercise-based cardiac rehabilitation6. SBP < 140mmHg7. Sexual activity can be resumed early if adjusted to physical abilityModification of lipid profileLipid-lowering treatment should be started as early as possible, as this increases patient adherence after discharge. Lipids should be re-evaluated4–6weeks after the ACS to determine whether the target levels have been reached and regarding safety issues.Antiplatelet Agents1. For long-term prevention, low aspirin doses (75–100mg) are indicated. 2. Combining aspirin and a P2Y12 inhibitor is recommended in patients with STEMI who are undergoing primary PCI (for up to 12months). 3. Clopidogrel is recommended for 1month in patients treated with fibrinolysis without subsequent PCI. Expending the duration of DAPT up to 12 months should be considered in these patients.4. Proton-pump inhibitor PPI is recommended for patients with a history of gastrointestinal bleeding and is appropriate for patients with multiple risk factors for bleeding.NitratesAlthough these agents are suitable for the management of specific conditions after STEMI or as part of a treatment regimen for congestive heart failure, little evidence indicates that reduce mortality over the long term when prescribed on a routine basis to all patients with infarction.Beta-Adrenergic blocking agentsBeta-blockers are recommended in patients with reduced systolic LV function (LVEF <_40%), in the absence of contraindications.Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockersTreatment with ACE inhibitors is recommended in patients with systolic LV dysfunction or heart failure, hypertension, or diabetes.Calcium antagonists In patients with contraindications to beta-blockers, calcium antagonists are a reasonable option for patients without heart failure or impaired LV function, such as hypertension or residual angina.Mineralocorticoid/aldosterone receptor antagonists Mineralocorticoid receptor antagonist (MRA) therapy is recommended in patients with LV dysfunction (LVEF <_40%) and heart failure after STEMI