ACE-INHIBITOR THERAPY AFTER MYOCARDIAL-INFARCTION - A NEW TREATMENT STRATEGY

Potential benefit or harm of drug therapy in patients with chronic con gestive heart failure and those later presenting to hospital after an acute myocardial infarction (AMI) have been studied in a number of lar ge-scale survival studies during the last few decades. Currently avail able data are reviewed in order to consider both methodology and also the clinical relevance of findings with emphasis on trials with ACE-in hibitors like CONSENSUS-tl, the ISIS-4, GISSI-3 and Chinese mega-trial s, TRACE, SAVE and AIRE. Results of SAVE and AIRE show a clear surviva l benefit for the patients. Furthermore, the benefit of both trials wa s in addition to any other benefit which resulted from aspirin, thromb olytic and beta-blocker therapies. In absolute terms, treatment of 1 0 00 patients with ramipril (AIRE) for 1 year would be expected to resul t in the prevention/delay of 40 premature deaths. The beneficial effec ts of ramipril were clearly apparent by 30 days though additional bene fit beyond this point was also present. Furthermore, prespecified subg roup analysis revealed significant benefit for patients at risk like w omen and the elderly. A selective approach is argued for the treatment of patients with ACE-inhibitors after myocardial infarction.