EVIDENCE-BASED, COST-EFFECTIVE RISK STRATIFICATION AND MANAGEMENT AFTER MYOCARDIAL-INFARCTION

Current management of patients after an acute myocardial infarction (A MI) reflects a variety of approaches ranging from conservative to aggr essive. Although each method is appropriate in certain subgroups, thei r application frequently lacks a scientific basis. Current, clinically relevant, evidence-based practice guidelines are needed for secondary prevention for survivors after an AMI. To meet this need, the Califor nia Cardiology Working Group was assembled to evaluate the available d ata from clinical trials and other published studies and develop evide nce-based, cost-effective guidelines for clinicians to use as a basis for patient management after an AMI. The group consisted of 18 members , including cardiologists from academic institutions and physicians wo rking in cardiac intensive care, private practices, and managed care s ettings, representing a broad spectrum of expertise pertaining to pati ents who have had an AMI. The members had expertise in cardiac intensi ve care, interventional cardiology, nuclear cardiology, lipid disorder s, echocardiography, and cardiac rehabilitation. The intended audience for these practice guidelines includes all physicians who treat survi vors of MI, A literature review of all relevant clinical trials and ot her published data about the natural history after AMI and the effects of current therapeutic modalities are discussed herein. Case historie s served as models for application of the literature-based data. The r ecommendations for management were reached by consensus vote based on the scientific evidence. When more than 1 management option applied, t his was recognized in the recommendations. The recommendations accompa ny the text.