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Review: The revised role of ACE-inhibition after myocardial infarction in the thrombolytic/primary PCI era

Organon, Oss, The Netherlands

Adriaan A Voors

Department of Cardiology, University Hospital Groningen, The Netherlands, a.a.voors{at}thorax.azg.nl

Francesco Fici

Excellence Research Center for Cardiovascular Disease, Department of Experimental Medicine, 2nd University of Naples, Italy

Dirk J van Veldhuisen

Department of Cardiology, University Hospital Groningen, The Netherlands

Wiek H van Gilst

Department of Clinical Pharmacology, University of Groningen, The Netherlands

Many studies have investigated the process of left ventricular (LV) dilatation and the effects of angiotensin-converting enzyme (ACE) inhibitors after myocardial infarction (MI). It has been generally accepted that progression of LV dilatation is a major predictor of heart failure and death after MI. Also, attenuation of LV dilatation is thought to be one of the main mechanisms by which ACE inhibitors (ACE-Is) produce their beneficial effects. However, evidence for this hypothesis came from studies that were performed before thrombolytic therapy and primary percutaneous coronary intervention (PCI) were routinely used after acute MI. Nowadays, reperfusion is obtained much more frequently and LV dilatation after MI has become less prevalent. Nevertheless, ACE-Is proved effective in reducing cardiac morbidity and mortality. Therefore, mechanisms other than attenuation of LV dilatation, such as anti-atherosclerotic effects or plaque stabilisation, may explain the long-term beneficial effects of ACE-Is after MI.

In the present overview, we evaluate the role of LV dilatation and the effects of ACE-Is after MI in the thrombolytic/primary PCI era and provide recommendations on ACE-I use in clinical practice.

Key Words: angiotensin-converting enzyme inhibitor • acute myocardial infarction • remodelling • secondary prevention

Journal of Renin-Angiotensin-Aldosterone System, Vol. 5, No. 4, 161-168 (2004)
DOI: 10.3317/jraas.2004.035


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