Clinical trials evaluating angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the setting of acute myocardial infarction

There is strong evidence from controlled clinical trials that in the setting of acute myocardial infarction complicated by heart failure or isolated left ventricular dysfunction, angiotensin-converting enzyme inhibitors started late during hospitalisation and continued in the long term, significantly reduced mortality and improved the prognosis. On the other hand, administration of angiotensin-converting enzyme inhibitors during the first 24 h in unselected patients with acute myocardial infarction provided only a slight benefit in terms of mortality. Angiotensin-II receptor blockers have and are being examined in the setting of acute myocardial infarction with left ventricular dysfunction and can provide an alternative for patients who cannot tolerate angiotensin-converting enzyme inhibitors. In this article, an evidence-based review of these major trials and suggestions for clinical application are presented.