oa Cardiovascular Journal of Africa - Which patients should receive an ACE inhibitor after acute myocardial infarction
By modifying left ventricular remodelling, improving endothelial dysfunction, interfering with neurohormonal activation and a host of other effects, angiotensin-converting enzyme (ACE) inhibitors have the potential to provide benefits to a large number of patients who have had a myocardial infarction. An impressive series of eight major Clinical trials demonstrates that, apart from extremely early intravenous treatment, an ACE inhibitor is the major factor improving survival after an acute myocardial infarction, whether given in the short or in the long term. The same series of trials have also demonstrated clearly that morbidity from heart failure is reduced. It is controversial whether re-infarctions are also less common. The SAVE study analyses of one of three available endpoints for this event showed re-infarctions to be reduced. Two other endpoints for acute myocardial infarction were not reduced. In contrast, re-infarctions were not significantly reduced in the AIRE and TRACE studies, which both had only one definition of a re-infarction. This discussion of which patients to select for ACE inhibition after acute myocardial infarction begins by examining the option to treat (nearly) everyone and then considers selective treatment for certain categories of patients.
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