Acute Myocardial Infarction: The Road Ahead

The mortality of cardiovascular disease in Israel has decreased by 65% in the last 15 years while the mortality of acute myocardial infarction is less than 4%.

Nonetheless, each infarct “bites” off another “chunk” of myocardium and this stepwise progression leads to severe heart failure.

The future unmet needs are:

1. More intensive primary prevention and modification of risk factors such as LDL reduction, obesity, diabetic control and hypertensive care.
2. Identification and management of sudden cardiac death in the first and subsequent myocardial infarction.
3. Reducing the delay in opening the culprit, obstructed coronary artery in STEMI and reducing the interval from pain onset to reperfusion to less than one hour.
4. Reducing the mortality in the first year after the acute episode by better hospital - general practitioner interaction, and improved education and rehabilitation of the patient
5. More extensive use of electronic surveillance and monitoring in the high-risk patients before the first clinical episode and all patients after the first episode.
6. Cell transplantation to replace damaged myocardium.

The plunging mortality and improved morbidity will continue to change the trajectory of atherosclerotic vascular disease.