EFFECTS OF THE EARLY ADMINISTRATION OF ZOFENOPRIL ON ONSET AND PROGRESSION OF CONGESTIVE-HEART-FAILURE IN PATIENTS WITH ANTERIOR WALL ACUTEMYOCARDIAL-INFARCTION

Chronic congestive heart failure (CHF) is a common disease responsible for a high mortality and morbidity whose clinical course can be impro ved by angiotensin-converting-enzyme (ACE) inhibition. However, limite d data are available on the effects of ACE inhibitors on the onset and progression of CHF in patients with acute myocardial infarction (AMI) , The present study was performed as a substudy of the Survival of Myo cardial Infarction Long-term Evaluation trial and involved 1,146 patie nts with anterior wall AMI not undergoing thrombolysis with the exclus ion of patients with prior history or clinical signs of CHF on admissi on. Patients were randomly allocated to treatment with zofenopril (7.5 to 30 mg twice daily) or placebo for a cumulative period of 6 weeks, The prevalence of CHF, either mild to moderate or severe, has been the main objective and has been evaluated b weeks and 1 year after AMI. T he overall prevalence of CHF was not reduced by zofenopril after both 6 weeks and 12 months. Conversely the prevalence of severe CHF (1.6% v s 2.6%: risk reduction 55.5%; 95% confidence interval 9 to 63; p = 0.0 325) and the combined occurrence of death or severe CHF (4.8% vs 8.2%: risk reduction 59%; 95% confidence interval 11 to 71; p = 0.024) were reduced after 6 weeks of treatment with zofenopril. Moreover, the per centage of patients experiencing a deterioration to severe CHF after 1 year was significantly reduced with zofenopril (11.0% vs 24.3%; p = 0 .001), In conclusion, the early administration of zofenopril to patien ts with AMI attenuates the progression of the clinical symptoms of CHF and its clinical consequences, suggesting that ACE inhibitors should be regarded as a suitable strategy for the prevention and treatment of CHF in patients with AMI.