Angiotensin-converting enzyme inhibitors are proved, effective agents for the treatment of
hypertension and
congestive heart failure. New data suggest that
angiotensin-converting enzyme inhibitors may be effective
therapy for patients following acute
myocardial infarction. Results from clinical trials, such as the Survival and Ventricular Enlargement trial, have demonstrated that
captopril attenuates left ventricular enlargement, minimizes and/or prevents the subsequent development of overt
congestive heart failure, and improves survival in patients with asymptomatic
left ventricular dysfunction after
myocardial infarction. Clinical reinfarctions and need for subsequent revascularization procedures were also reduced with
captopril. In the Acute
Infarction Ramipril Efficacy study, patients with clinically evident
heart failure following acute
myocardial infarction who received
ramipril demonstrated a significant reduction in mortality and cardiovascular events. The mortality benefit in this study was evident within 30 days, possibly reflecting differences in patients studied (ie, population with high-risk
heart failure in the Acute
Infarction Ramipril Efficacy study as opposed to population with asymptomatic
left ventricular dysfunction in the Survival and Ventricular Enlargement trial). Contrary results have been reported in another major postmyocardial
infarction trial, the Cooperative New Scandinavian
Enalapril Survival Study, which evaluated
enalaprilat/
enalapril maleate in unselected patients with acute
myocardial infarction. This article reviews the recent trials using
angiotensin-converting enzyme inhibition after
myocardial infarction and will explore the reasons why
angiotensin-converting enzyme inhibition seems to be beneficial in this clinical setting.