Early or late ACE inhibition after myocardial infarction.

There is justifiable enthusiasm for the use of angiotensin-converting enzyme (ACE) inhibitors in patients with heart failure. However, early after an acute myocardial infarction, the benefits (or harm) from use of these agents in individual patients may depend on the critical balance between the ischemic problem (the extent of coronary artery narrowing and risk of vessel occlusion) against the need to preserve remaining ventricular function. Patients who are hemodynamically stable without ongoing chest pain but with significantly impaired ventricular function seem likely to gain most from treatment with ACE inhibitors. Extrapolation to the acute infarct situation from the recently published trials in chronic stable heart failure may mislead, and the findings of a number of large ongoing mortality trials in patients with recent myocardial infarction are awaited.