ABSTRACT
After an acute myocardial infarction (AMI), elderly patients should have aggressive treatment of all modifiable coronary risk factors, including smoking cessation, treatment of hypertension, reduction in low-density lipoprotein (LDL)-cholesterol, improvement in glycemic control, and weight loss when appropriate. Regular physical activity, beginning with referral to a structured cardiac rehabilitation program, is highly recommended. The appropriate role of aspirin, thienopyridines, anticoagulants, ß-blockers, angiotensin-converting enzyme (ACE)inhibitors, aldosterone antagonists, and hormone replacement therapy in secondary prevention is discussed. Annual influenza vaccination should be offered. Consideration should be given to the use of implantable cardioverter-defibrillator (ICD) therapy and revascularization in those with guideline-directed indications. Among elderly post-MI patients with significant comorbidities and/or frailty, a focus on patient-centered outcomes other than survival alone may be most appropriate.
