Numerous large, double-blind, randomized trials have demonstrated that, overall, angiotensin converting enzyme (ACE) inhibition improves survival of patients after acute myocardial infarction (AMI). However, several practical issues concerning ACE inhibition in the presence of AMI have not yet been answered. These include whether ACE inhibition should be initiated in all patients with AMI, how soon ACE inhibition should be attempted in relation to onset of pain and possibly thrombolysis, and, lastly, how long ACE inhibition should be maintained after the acute event. Each of these issues is addressed, and recommendations are made on the basis of the results from recent randomized trials in AMI and congestive heart failure.
PfefferMABraunwaldE: Ventricular remodeling after myocardial infarction. Experimental observations and clinical implicationsCirculation1990, 81:1161–1172.
2.
LonnEMYusufSJhaPMontagueTJTeoKKBenedictCR: Emerging role of angiotensin converting enzyme inhibitors in cardiac and vascular protectionCirculation1994, 90:2056–2069.
3.
PfefferMABraunwaldEMoyeLABastaLBrownEJJrCuddyTE: Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the Survival and Ventricular Enlargement TrialN Engl J Med1992, 327:669–677.
4.
The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators: Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failureLancet1993, 342:821–828.
5.
Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico: GISSI-3: Effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarctionLancet1994, 343:1115–1122.
6.
AmbrosioniEBorghiCMagnaniB, For the Survival of Myocardial Infarction Long-Term Evaluation (SMILE) Study Investigators: The effect of the angiotensin converting-enzyme inhibitor zofenopril on mortality and morbidity after anterior myocardial infarctionN Engl J Med1995, 332:80–85.
7.
DavisRRibnerHSKeungESonnenblickEHLeJemtelTH: Treatment of chronic congestive heart failure with captopril, an oral inhibitor of angiotensin converting enzymeN Engl J Med1979, 301:117–121.
8.
ISIS-4 Collaborative Group: Fourth International Study of Infarct Survival: Protocol for a large simple study of the effects of oral mononitrate, of oral captopril and of intravenous magnesiumAm J Cardiol1991, 68:87D–100D.
9.
SwedbergKHeldPKjekshusJRasmussenKRydenLWedelH, On behalf of the CONSENSUS II Study Group: Effects of the early administration of enalapril on mortality in patients with acute myocardial infarction. Results of the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II)N Engl J Med1992, 327:678–684.
10.
KlonerRAParisiAF: Acute myocardial infarction: Diagnostic and prognostic applications of two-dimensional echocardiographyCirculation1987, 75:521–524.
11.
PicardMHWilkinsGTRayPAWeymanAE: Natural history of left ventricular size and function after acute myocardial infarction. Assessment and prediction by echocardiographic endocardial surface mappingCirculation1990, 82:484–494.
12.
ThanavaroSKleigerREProvinceMAHubertJWMillerJPKroneRJ: Effect of infarct location on the in-hospital prognosis of patients with first transmural myocardial infarctionCirculation1982, 66:742–747.
13.
StonePHRaabeDSJaffeASGustafsonNMullerJETuriZG: Prognostic significance of location and type of myocardial infarction: Independent adverse outcome associated with anterior locationJ Am Coll Cardiol1988, 11:453–463.
14.
EatonLWWeissJLBulkleyBHGarrisonJBWeisfeldtML: Regional cardiac dilatation after acute myocardial infarction: Recognition by two-dimensional echocardiographyN Engl J Med1979, 300:57–62.
15.
GaudronPEillesCKuglerIErtlG: Progressive left ventricular dysfunction and remodeling after myocardial infarction. Potential mechanisms and early predictorsCirculation1993, 87:755–763.
Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI): Effectiveness of intravenous thrombolytic treatment in acute myocardial infarctionLancet1986, i:397–402.
18.
ISIS-2 (Second International Study of Infarct Survival) Collaborative Group: Randomized trial of intravenous streptokinase, oral aspirin, both or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2Lancet1988, ii:349–360.
19.
NabelEGTopolEJGaleanaAEllisSGBatesERWernsSW: A randomized placebo-controlled trial of combined early intravenous captopril and recombinant tissue-type plasminogen activator therapy in acute myocardial infarctionJ Am Coll Cardiol1991, 17:467–473.
20.
PrewittRMGuSGarberPJDucasJ: Marked systemic hypotension depresses coronary thrombolysis induced by intracoronary administration of recombinant tissue-type plasminogen activatorJ Am Coll Cardiol1992, 20:1626–1633.
KinchJWRyanTJ: Right ventricular infarctionN Engl J Med1994, 330:1211–1117.
23.
McKayRGPfefferMAPasternakRCMarkisJEComePCNakaoS: Left ventricular remodeling after myocardial infarction: A corollary to infarct expansionCirculation1986, 74:693–702.
24.
St John SuttonMPfefferMAPlappertTRouleauJLMoyeLADegenaisGR: Quantitative two-dimensional echocar-diographic measurements are major predictors of adverse cardiovascular events after acute myocardial infarction. The protective effects of captoprilCirculation1994, 89:68–75.
25.
CigarroaRGLangeRAHillisLD: Prognosis after acute myocardial infarction in patients with and without residual anterograde coronary blood flowAm J Cardiol1989, 64:155–160.
26.
YusufSPepineCJGarcesCPouleurHSalemDKostisJ: Effect of captopril on myocardial infarction and unstable angina in patients with low ejection fractionsLancet1992, 340:1173–1178.
27.
KonstamMARousseauMFKronenbergMWUdelsonJEMelinJStewartD: Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dysfunction in patients with heart failureCirculation1992, 86:431–438.
