IMPROVING OUTCOME AFTER ACUTE MYOCARDIAL-INFARCTION - WHAT IS THE ROLE OF ACE-INHIBITORS

Acute myocardial infarction continues to be the number 1 killer in ind ustrialised countries, While the more widespread use of thrombolytic t herapy has made a dramatic impact on patient survival, changes in long -term prognosis after discharge from hospital have not improved radica lly and 5-year mortality remains at over 30%, The single most importan t determinant of survival in the long term is left ventricular functio n, The process of ventricular dilatation and remodelling begins early after infarction. While such changes may initially go unrecognised cli nically, without intervention progressive functional impairment will e nsue and the majority of patients will develop signs and symptoms of h eart failure, which carries a worse prognosis than many forms of cance r, ACE inhibitors act on both the haemodynamic and neurohormonal mecha nisms in heart failure, Several large-scale clinical trials have clear ly demonstrated that early use of these agents in stable patients who are not hypotensive or in cardiogenic shock can reduce significantly t he development of heart failure and death, A strategy for the early in itiation of ACE inhibitor therapy is proposed to improve survival in A MI patients.