Monitoring

Close monitoring and treatment is essential. An inpatient follow-up should be arranged within the first 1 to 2 weeks of discharge. Monthly visits should be scheduled thereafter. Lipids should be monitored at least every 6 months until a target low-density lipoprotein <70 mg/dL is reached in patients who have had a myocardial infarction or have coronary artery disease. The need for follow-up cardiac ultrasounds is at the discretion of the physician. However, cardiac ultrasounds are necessary to evaluate and monitor ventricular function.[2]

It is crucial to assist smoking cessation efforts and promote a physical activity regimen. If available, cardiac rehabilitation is extremely helpful. Psychosocial risk factors such as anxiety and depression should be addressed. Depression in particular has been associated with a poor prognosis.[46] All medications should be reviewed at every follow-up visit to encourage patient compliance and optimal dosing.[2]

In patients who have undergone direct reperfusion, further noninvasive stress testing or further imaging is indicated only if stenosis of intermediate severity (luminal narrowing of 50% to 70%) is present in a nonculprit artery. Patients with recurrent ischemic-type pain after reperfusion may need angiography after medical therapy to evaluate for further stenosis or occlusion.[64]

All patients, regardless of whether a stent was placed, should be treated with a P2Y12 inhibitor for up to 12 months and low-dose aspirin daily as long as tolerated. There is some evidence that patients treated with bare metal stents (BMS) are at an increased risk for repeat procedural care compared to those treated with drug-eluting stents (DES). P2Y12 inhibitors for patients with acute coronary syndrome NSTEMI should be continued for at least 12 months in all patients despite treatment strategy of medical management, balloon angioplasty, lytic therapy, BMS placement, or DES placement. For selected patients with stable coronary artery disease receiving percutaneous coronary intervention, shorter duration (1-3 months) of dual antiplatelet therapies may be considered with subsequent transition to P2Y12 inhibitor monotherapy to reduce the risk of bleeding events.[64][153] A scientific advisory from several major health organizations describes the risks of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents.[138]

Use of this content is subject to our disclaimer