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ARTICLE |

ACE Inhibitors After Acute Myocardial Infarction

Tsung O. Cheng, MD
Arch Intern Med. 1995;155(6):645. doi:10.1001/archinte.1995.00430060109018.
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The comprehensive review of different angiotensin converting enzyme (ACE) inhibitor trial results in patients with acute myocardial infarction presented by Cody1 is timely and excellent. Although the beneficial role of ACE inhibitors in congestive heart failure has now been well established by several major trials, results from some other trials are contradictory.

Why was ACE inhibitor therapy apparently ineffective or even harmful when it was started very early, eg, in the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II)2? Besides the reasons mentioned by Cody, I would like to suggest a couple more. First, the CONSENSUS II investigators used a treatment that might have an adverse effect on early mortality in one subgroup and an inadequate follow-up period to demonstrate a favorable effect in another subgroup. These results are reminiscent of the findings of the Veterans Administration Cooperative Study of the effect of nitroprusside in acute myocardial

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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