Cardiology. II. Coronary heart disease, myocardial infarction

Within the last 30 years pharmacotherapy has significantly contributed to an improvement of the prognosis of patients with coronary artery disease. With regard to antianginal drugs beta-blocker therapy has in particular enabled a risk reduction in patients with unstable angina, acute myocardial infarction and following acute myocardial infarction. Antithrombotic therapy has largely been influenced by platelet inhibitors. Acetylsalicylic acid (ASA) has convincingly shown to enable a risk reduction in patients with stable angina, unstable angina, acute myocardial infarction and in the secondary prevention following myocardial infarction. The introduction of thienopyridines has led to a further improvement of antiplatelet therapy. Thus, the combination of ticlopidine + ASA was combined with a significant risk reduction of subacute stent thrombosis and has enabled stent implantation to become a breakthrough technology. Clopidogrel, another thienopyridine has been shown to be superior in comparison to a monotherapy with ASA in patients with atherothrombotic diseases. The introduction of glycoproteine-IIb-IIIa-receptor antagonists has led to a significant risk reduction of periinterventional complications in patients with unstable angina. The combination of heparin + ASA was clearly superior to a monotherapy with ASA in patients with unstable angina. Recently, a further improvement of prognosis with low molecular weight heparin has been reported. Due to somewhat conflicting results, the definite role of direct thrombin inhibitors like hirudin still has to be defined. A possible risk reduction in patients with unstable coronary syndromes has been reported. Reperfusion therapy with fibrinolytic agents has revolutionised the therapy of patients with acute myocardial infarction throughout the last decades. In numerous trials successful fibrinolysis has convincingly shown to improve the prognosis of patients with acute myocardial infarction and thus is still considered to be the gold standard of treatment in acute myocardial infarction.