[ACE-inhibitors in acute heart infarct]

Area of Science:

• Cardiology
• Pharmacology

Context:

• Established use of ACE-inhibitors in heart failure.
• Uncertainty regarding early ACE-inhibitor use in acute myocardial infarction (MI) for preventing left ventricular dilatation.

Purpose:

• To evaluate the efficacy and safety of early ACE-inhibitor treatment in the acute phase of myocardial infarction.
• To assess the impact of ACE-inhibitors on mortality and identify high-risk patient groups benefiting from this intervention.

Summary:

• Large trials (ISIS-4, GISSI-3) demonstrated that early ACE-inhibitor administration in acute MI is safe, dispelling concerns about hypotension.
• A 7% reduction in mortality was observed, translating to five lives saved per 1000 treated patients.
• ACE-inhibitors can be administered after standard MI therapy (antiplatelets, thrombolysis, beta-blockers) if contraindications like severe hypotension or renal failure are absent.

Impact:

• ACE-inhibitors are recommended in the acute phase of MI, following customary therapies and contraindication assessment.
• Further analysis will clarify benefits for high-risk populations (Killip > 1, age > 70, prior renal failure).
• ACE-inhibitors remain the primary treatment for patients developing left ventricular failure post-MI.