What are the “five fingers” of post-MI care?

Every patient who has suffered a STEMI should leave the hospital on an appropriate regimen for post-MI care. It is important to note that the “five fingers” are a generalization and individual patient cases will vary.  These are:

1. Aspirin: antiplatelet agent. If a patient has GI upset or cannot take aspirin for some other reason, start them on clopidogrel (also antiplatelet).

2. Beta-blocker: associated with short and long-term survival, and especially beneficial for LV infarcts. The two beta-blockers with proven mortality benefit are Metoprolol XL and Carvedilol.

3. Clopidogrel: give this in addition to aspirin, because it has additive beneficial effects. This review article is helpful for outlining when to stop clopidogrel, because there are different scenarios (like elective CABG, bare-metal stents vs drug-eluting, etc).

4. ACE inhibitors: have proven mortality benefit. They are especially useful in LV infarcts. Patients should be on them indefinitely.

5. Statin: Likely, the patient is already on a statin, but if not, start them on one. Statins reduce LDL, and may also help with plaque stabilization. Patients should be on them indefinitely.

Additional medications that can be helpful are nitrates (relieving anginal pain), and ARBs (if ACE inhibitors cannot be used), but these do not have the same level of mortality benefit as the aforementioned drugs.

For a more detailed overview, see this extra from the ACP on post-MI care.

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