Clinical assessment of indication for ACE-inhibitor treatment early after acute myocardial infarction

An investigation was conducted to assess whether an algorithm based on simp le clinical information would suffice to classify patients with acute myoca rdial infarction, with respect to indication for angiotensin-converting-enz yme inhibitor treatment. One hundred consecutive patients with myocardial i nfarction were prospectively studied. Based on clinical, radiological, elec trocardiographic and biochemical information, the patients were classified as having (a) significantly depressed left ventricular function (ejection f raction less than or equal to 40%) justifying treatment with angiotensin-co nverting-enzyme inhibitors (ACEI), (b) preserved ventricular function (ejec tion fraction >40%) making ACEI unnecessary, or (c) indeterminate ventricul ar function, requiring further examination. Using a blinded design, ejectio n fraction was determined by echocardiography and radionuclide ventriculogr aphy. A clinical assumption of reduced left ventricular function had a pred ictive value of an echocardiographically determined ejection fraction less than or equal to 40% of 83% (n = 23). Clinical criteria of good ventricular function had a predictive value of ejection fraction >40% of 96% (n = 24). In these two groups clinical misclassification occurred in five patients w ith ejection fraction within the range of 39-45%. Left ventricular function was found to be clinically indeterminate in 53 of the 100 patients. Ejecti on fraction values assessed by radionuclide ventriculography (n = 44) were on average 9.3%-points lower than echocardiographic values. The indication for ACEI can apparently be determined on the basis of readily available cli nical information in approximately 50% of patients with acute myocardial in farction.