[ACE inhibitors after myocardial infarction: close-up on zofenopril]

The angiotensin-converting enzyme (ACE) inhibitors have a necessary place in the follow-up of myocardial infarction. Their benefits have been extended little by little. When clinical trials conducted with zofenopril began with a vast study program called SMILE, certain questions remained unanswered, notably the long-term benefit of the ACE inhibitors beyond a short administration period. SMILE (Survival of Myocardial Infarction Long-Term Evaluation), begun in 1995, is studying zofenopril to determine the effects of using this ACE inhibitor in the follow-up of myocardial infarction. During the course of the different study phases, zofenopril has successively demonstrated benefits on the reduction of morbidity and mortality after anterior myocardial infarction in STEMI patients, benefits that are maintained over the long term, since at 1 year, the mortality rate is significantly lower in the zofenopril group compared to the placebo group. SMILE's analyses have shown the value of zofenopril in subpopulations, particularly at-risk patients, hypertensive patients, and diabetics, whose prognosis after infarction is more severe than in populations without hypertension or diabetes. Zofenopril can be administered early, even in a more favorable situation, to myocardial infarction patients with no ST-segment elevation (NSTEMI). The SMILE program is continuing, notably with SMILE IV, where it is being compared to ramipril, and in the ZAAMIS trial, designed to confirm its vasculoprotective effects.