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Heart attack and acute coronary syndrome

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of heart attack.

Alternative Names

Acute coronary syndrome; Myocardial infarction

Highlights

Vitamin B

Folic acid and vitamin B supplements do not help prevent second heart attacks, suggest a 2006 study in the New England Journal of Medicine . Moreover, high doses of these vitamins may be harmful for patients who have stents in their coronary arteries.

NSAIDs and COX-2 Inhibitors

People who have previously had a heart attack should not take pain medication like ibuprofen (Advil, Motrin) or celecoxib (Celebrex) without first talking to their doctor. Research presented at the American Heart Association’s annual meeting indicated that high doses of COX-2 inhibitors, and some nonsteroidal anti-inflammatory drugs (NSAIDs), may increase the risk of death for heart attack survivors.

Pregnancy and Heart Attacks

Pregnant women who have diabetes, high blood pressure, or coronary artery disease are at increased risk for having a heart attack. The risk is greatest for women 40 years and older.

Drug Research

• Fondaparinux (Arixtra) is a blood-thinning drug that is showing promise as an alternative to heparin for both higher-risk patients who have had a severe heart attack and lower-risk patients with acute coronary syndrome (ACS).
• Clopidogrel (Plavix) and aspirin may not work as well as aspirin alone in preventing a first heart attack, according to controversial research published in the New England Journal of Medicine . However, experts agree that this drug combination is very helpful for patients who have already had a heart attack. Clopidogrel is also important for patients undergoing angioplasty and stenting.
• Abciximab (ReoPro) can help reduce the risk of a heart attack in patients with ACS who require angioplasty, according to the Journal of the American Medical Association . Abciximab is given along with clopidogrel and other drugs in the days before surgery.
• Stents coated with the drug sirolimus work better than bare metal stents for patients with diabetes, according to a study in Circulation .

• Review Date: 4/15/2006
• Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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