MYOCARDIAL-INFARCTION - WHEN AND HOW SHOULD WE INITIATE TREATMENT WITH ACE-INHIBITORS

Recent trials have shown that angiotensin-converting enzyme (ACE) inhi bitors can reduce mortality and the occurrence of severe left ventricu lar dysfunction (LVD) when started within the first day after acute my ocardial infarction and continued for 4-6 weeks thereafter. When start ed within this time window, ACE inhibitors are safe in relatively unse lected myocardial infarction (MI) patients provided they are clinicall y and hemodynamically stable. GISSI-3, ISIS-4 and CCS-1 studies show t hat more than half of the lives are saved by ACE inhibitor treatment w ithin the first week of therapy. Although the benefit from ACE inhibit ors is larger in patients presenting with congestive heart failure (Ki llip class > 1), the number of lives saved in patients at low risk, wh o represent the majority of the population, is relevant. This supports the approach of treating all hemodynamically stable MI patients. Trea tment could be stopped after about 1 month in patients without evidenc e of LVD while those with LVD should follow a long-term therapy with A CE inhibitors.