Rather, its use is limited to subgroups of patients in whom it has clearly been shown to prolong life or improve quality of life. Two major forces have converged to bring us into the evidence-based coronary care phase. The first is the widespread agreement that it is no longer acceptable to base the use of diagnostic tests and therapeutic measures on anecdotal experience or on the results of retrospective cohort studies, especially for a condition such as acute myocardial infarction, which is so common and has been studied so intensively. The second is the advent of managed, particularly capitated, care, which places such a high priority on reducing costs by using only those diagnostic tests and therapeutic interventions that have a proven effect on clinical outcome. Early attention to secondary prevention is likely to result in substantial further improvement in long-term outcome.
Many challenges remain in the care of patients with acute myocardial infarction.
Most of the deaths are sudden and occur before the patient reaches the hospital. Most of the remainder result from massive infarctions that cause cardiogenic shock or internal or external cardiac rupture. In the future, an increasing focus on patient behavior will be required. The new generation of antiplatelet agents will be of increasing interest. Oral forms of these inhibitors have been developed, and large-scale testing of these agents in patients who have had acute myocardial infarction is about to begin.