PMID: 8949316Aug 1, 1996Paper

Treatment by angiotensin converting enzyme inhibitors after myocardial infarction. What did the clinical trials teach us?

Archives des maladies du coeur et des vaisseaux
P GuéretP Barnier

Abstract

Most clinical trials of angiotensin converting enzyme inhibitors after myocardial infarction have shown an improved outcome with reduction of morbidity and mortality. In comparable groups of patients, the results are concordant with a decrease in mortality which is all the more significant and early in severe infarction with serious haemodynamic consequences. The clinician has a new arm in his therapeutic arsenal either for use in the acute phase of all cases of myocardial infarction but for only a short period of 4 to 6 weeks after which the treatment is withdrawn when the anatomical sequellae are more moderate, or for use in selected cases for longer periods (patients with severe infarction with cardiac failure and/or severe left ventricular dysfunction). The second attitude has the advantage of treating a selected population which will derive greater benefits. In all cases, treatment should be started orally at low doses, and the dose must be increased rapidly do attain the target dosage under close clinical and biological surveillance. When the classical contraindications are respected, ACE inhibitors seem to be well tolerated even at the relatively high dosages recommended after myocardial infarction. Hypotension and, more...Continue Reading

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