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All pts post MI should be on
''ACEi, BB, Aspirin, Statin''
Clopidogrel for first 12/12
Aldosterone antagonist (Eplerenone) - post MI with heart failure and LV systolic dysfuntion (start at 3-14 days post ACEi)

Ischaemic cardiac events 
mostly caused by atheromatous plaques causing acute obstruction of coronary vessels
inc if diabetic, smoker, HT cholesterol, age

Aspirin reduces risk of events in high risk even at low dose
Bleeding risk is less than ischaemic events risk and dec with dec dose

Aspirin and Clopidogrel together is better than aspirin alone for first 9/12. Prasugrel better still.
Bleeding risk inc with AandC but not life threatening bleed. Risk of bleeding is higher with Prasugrel.

Aspirin and warfarin - dec events but no change in mortality
bleeding risk inc

Warfarin alone is more effectigve than aspirin but less convenient and more bleeding so AandC usually preferred

Clopidogrel cf Aspirin
C is slightly more effective with less bleeding but more diarrhoea and rash

Other drugs
BB - beneficial in HF - inc tiredness ?
ACEi - beneficial in HF - inc cough, hypotension, renal dysfunction and hyperK
ARB - less evidence but also beneficial - more hypoT than ACEi
ACEi and ARB - no added benefit
CCB - less useful
Class 1 antiarrythmics (Flecainide, Quinidine etc) - inc mortality - DON'T use
Amiodarone - dec mortality but lots SE - hypothyroidism, hyperthyroidism, peripheral neuropathy, lung infiltrates, bradycardia, and liver dysfunction
HRT - no cardiovascular benefit

Cholesterol reduction
Statins dec mortality in line with dec in cholesterol
SE - rhabdomyolysis(3.4), myopathy(11), peripheral neuropathy (12) out of 100,000

Antioxidants - no effect
Cardiac rehab - helpful
Diet - Mediterannean and fish oils - benefit, low fat and high fibre - no effect
smoking cessation - benefit

Outcome
By 1 yr post MI 25%M 38%F will die
By 6yrs post MI 18%M 35%F will have another MI, 22%M 46%F will have heart failure 7%M 6%F will have sudden death