Angiotensin-Converting Enzyme Inhibition after Myocardial Infarction

Myocardial infarction was the underlying event in the majority of deaths from cardiovascular disease in Western countries in the past quarter-century. The introduction of angiotensin-converting enzyme inhibitors to the treatment of heart failure following myocardial infarction was a major advance in the last 10 years. However, the role of cardiac angiotensin-converting enzyme during postinfarction cardiac remodeling remains to be elucidated. Experimental studies demonstrated that angiotensin-converting enzyme inhibitors administered one week before myocardial infarction could limit infarct size, improve cardiac function, and prevent cardiac hypertrophy. Numerous large-scale clinical trials have shown that angiotensin-converting enzyme inhibitors are safe and can reduce mortality and the occurrence of severe left ventricular dysfunction after myocardial infarction. This review focuses on the effects of these inhibitors in experimental studies and in multicenter clinical trials.