Very early administration of ACE-inhibitors in acute myocardial infarction

Recent trials have shown that ACE-inhibitors are safe and can reduce mortality and the occurrence of severe left-ventricular dysfunction (LVD) (when started within the first day after acute myocardial infarction (MI) and continued for 4 to 6 weeks thereafter). 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-inhibitor 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 evidences of LVD while those with LVD should be continued on ACE-inhibitors for a long period of time.