POST ACUTE MYOCARDIAL-INFARCTION - THE FOSINOPRIL IN ACUTE MYOCARDIAL-INFARCTION STUDY (FAMIS)

Many studies have clearly documented the beneficial effects of angiote nsin converting enzyme (ACE) inhibitors in patients with acute myocard ial infarction (AMI). The Fosinopril in Acute Myocardial Infarction St udy (FAMIS) was a 2-year randomized, double-blind, placebo-controlled multicenter study investigating the hemodynamic and clinical effects o f early (< 9 h from onset of symptoms) administration of fosinopril in 285 patients with anterior AMI undergoing thrombolysis within 6 h of symptom onset. The objective of the study was twofold: 1) to estimate changes in left ventricular (LV) volumes and function over 3 months by a series of echocardiographic evaluations, and 2) to clinically asses s mortality and the occurrence of congestive heart failure (CHF) over 2 years. LV volumes measured at baseline (24 to 48 h from symptom onse t) were within the normal range in over two-thirds of randomized patie nts, and the changes in volume were comparable after 3 months of treat ment with either fosinopril or placebo. However, fosinopril-treated pa tients showed a 30% reduction in the 2-year incidence of death or mode rate-to-severe CHF (P = .04) despite having a worst prognostic profile at baseline. This benefit of fosinopril was confirmed in the subgroup of patients without CHF on admission, who showed a 34.1% reduction in the 2-year occurrence of CHF (P = .05) and a 29.1% reduction in death or CHF (P = .04). The results of the FAMIS study suggest that early t reatment with fosinopril, in conjunction with thrombolysis, can signif icantly delay the development of CHF in patients with AMI, acting thro ugh mechanisms independent of fosinopril's impact on LV remodeling. (C ) 1997 American Journal of Hypertension, Ltd.