Table 3.11-4. Long-term postdischarge pharmacotherapy as secondary prevention in patients with acute coronary syndrome

Agent and dosage

Indications

ASA 70-100 mg/d

Lifelong in all patients unless contraindicated

Clopidogrel 75 mg once daily

 

 

or

Ticagrelor 90 mg bid

 

or

Prasugrel 10 mg once daily

– Lifelong in patients with ASA contraindications or intolerance

– Combined with ASA for 12 months after ACS

 

– Combined with ASA for 12 months after ACS

 

 

 

– Combined with ASA for 12 months after ACS

Beta-blocker

– All patients after UA/NSTEMI with LV dysfunction unless contraindicated

– All patients after STEMI unless contraindicated

ACEI

– Patients after UA/NSTEMI with heart failure, LV dysfunction (LVEF <40%), hypertension, diabetes mellitus, or chronic kidney disease. Consider in all other patients as prevention of further ischemic events

– All patients after STEMI

Statin

All patients (unless contraindicated) regardless of baseline cholesterol levels. Target LDL-C <1.8 mmol/L (70 mg/dL)

ARB

All patients who do not tolerate ACEI, and particularly those with heart failure and LV dysfunction (LVEF <40%)

Aldosterone antagonist

Patients after MI treated with beta-blockers and ACEI with LVEF <40% and with diabetes mellitus or heart failure but without significant renal dysfunction or hyperkalemia

Based on Eur Heart J. 2016;37(3):267-315 and Eur Heart J. 2018;39(2):119-177.

ACEI, angiotensin-converting enzyme inhibitor; ACS, acute coronary syndrome; ARB, angiotensin-receptor blocker; ASA, acetylsalicylic acid; bid, 2 times a day; LDL-C, low-density lipoprotein cholesterol; LV, left ventricle; LVEF, left ventricular ejection fraction; MI, myocardial infarction; NSTEMI, non–ST-segment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction; UA, unstable angina.