Pharmacotherapy of acute myocardial infarction

Kardiovaskularne bolesti su vodeći uzrok smrtnosti u svijetu, a najčešće ljudi umiru od ishemijske bolesti srca. Akutni infarkt miokarda (AIM) kao najopasnija manifestacija ishemijske bolesti srca najčešće nastaje rupturom aterosklerotskog plaka na stjenci koronarne arterije kojeg slijedi prianjanje, aktivacija i agregacija trombocita, te aktivacija koagulacijske kaskade i formiranja tromba. Temelj liječenja AIM je koronarna revaskularizacija kojom se uspostavlja i poboljšava koronarni protok kako bi se sačuvalo čim više zdravog miokarda, a u načelu se postiže perkutanom koronarnom intervencijom (PCI), fibrinolizom ili aortokoronarnim premoštenjem. Farmakoterapija ima također ključnu ulogu u liječenju infarkta miokarda jer bez adekvatne primjene lijekova sama revaskularizacija neće ispoljiti značajan benefit za bolesnike. Dio bolesnika s AIM niti ne bude podvrgnut revaskularizaciji te je liječen strategijom baziranom dominantno na farmakoterapiji. Lijekovi u infarktu miokarda između ostaloga imaju zadaću da smanje ishemiju srčanog mišića, preveniraju koronarni tromboembolizam, poboljšaju protok krvi kroz stenotičke lezije i ugrađene stentove, smanje zahtjev miokarda za kisikom, održavaju otvorenost krvne žile i kontroliraju bol. Dugoročni ciljevi liječenja su prevencija novih ishemijskih događaja, kontrola rizičnih čimbenika te poboljšanje i produljenje života bolesnika. U ovom radu prikazan je pregled suvremene farmakoterapije AIM u prehospitalnom, hospitalom i posthospitalnom razdoblju uz osvrt na samu bolest i aktualna klinička istraživanja u ovom području koja traže nove načine da se reduciraju katastrofalne posljedice infarkta miokarda koji je već desetljećima jedan od najvećih javnozdravstvenih i društvenih problema.
Cardiovascular diseases are the leading cause of death worldwide, and most people die from ischemic heart disease. Acute myocardial infarction is the most dangerous manifestation of ischemic heart disease and is usually caused by atherosclerotic plaque disruption in the coronary artery wall. Subsequently, platelet adherence, activation and aggregation occur, leading to the activation of the clotting cascade and clot formation. Coronary revascularization is the cornerstone treatment in myocardial infarction management to preserve and maintain as much myocardium as possible. It can be performed with percutaneous coronary intervention, fibrinolysis or coronary artery bypass grafting. Pharmacotherapy also plays a key role in myocardial infarction management because coronary revascularization cannot achieve desired benefit without concomitant medications. Part of the patients with myocardial infarction do not undergo revascularization and are treated predominantly with pharmacotherapy. Drugs used in patients with myocardial infarction, amongst other positive effects, reduce myocardial ischemia, prevent coronary thromboembolism, increase blood flow through stenotic lesions and implanted stents, reduce myocardial oxygen demand, preserve patency of the coronary artery and control pain. Long-term goals in treating myocardial infarction with medications are prevention of new ischemic events, risk factors control and improvement in patients' survival and quality of life. This graduate thesis reviews contemporary acute myocardial infarction pharmacotherapy in prehospital, hospital and posthospital setting, with reference to the disease itself and the ongoing clinical research in this area which is exploring new ways to reduce catastrophic consequences of this disease which has for decades been one of the major issues in public health and society in general.