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      Myocardial Infarction: When and How Should We Initiate Treatment with ACE Inhibitors?

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          Abstract

          Recent trials have shown that angiotensin-converting enzyme (ACE) inhibitors can reduce mortality and the occurrence of severe left ventricular dysfunction (LVD) when started within the first day after acute myocardial infarction and continued for 4-6 weeks thereafter. When started within this time window, ACE inhibitors are safe in relatively unselected myocardial infarction (MI) patients provided they are clinically and hemodynamically stable. GISSI-3, ISIS-4 and CCS-1 studies show that more than half of the lives are saved by ACE inhibitor treatment within the first week of therapy. Although the benefit from ACE inhibitors is larger in patients presenting with congestive heart failure (Killip class > 1), the number of lives saved in patients at low risk, who represent the majority of the population, is relevant. This supports the approach of treating all hemodynamically stable MI patients. Treatment could be stopped after about 1 month in patients without evidence of LVD while those with LVD should follow a long-term therapy with ACE inhibitors.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          978-3-8055-6272-0
          978-3-318-01963-6
          0008-6312
          1421-9751
          1996
          1996
          19 November 2008
          : 87
          : Suppl 1
          : 16-22
          Affiliations
          GISSI-3 Coordinating Group, Istituto di Ricerche Farmacologiche ‘Mario Negri’, Milano, and Associazione Nazionale Cardiologi Ospedalieri (ANMCO), Milano and Firenze, Italy
          Article
          177163 Cardiology 1996;87:16–22
          10.1159/000177163
          8681316
          © 1996 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 7
          Categories
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