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Post-STEMI Management — RACP Adult Medicine MCQ

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HardCardiologyPost-STEMI ManagementRACP Adult Medicine

A 48-year-old man presents with an acute inferior STEMI. Following successful PCI, his echo shows LVEF 35% with inferior akinesis. He has no contraindications. What is the most appropriate secondary prevention regimen (in addition to dual antiplatelet therapy)?

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Correct answer: A — Aspirin + ticagrelor + statin + ACEi + beta-blocker + eplerenone

Post-ACS with LVEF ≤40% and heart failure, the 2025 Australian ACS guidelines strongly recommend the combination of DAPT (aspirin + ticagrelor), high-intensity statin, ACEi, beta-blocker, and MRA (eplerenone). The addition of eplerenone is now a strong recommendation in this specific population per the updated guideline. ARNI is recommended against in the immediate post-ACS setting.

Reference: NHFA/CSANZ – 2025 – ACS Secondary Prevention Guidelines