The effects of ACE inhibition on ischemic cardiac events: Pump failure, reinfarction, hospitalization for angina, and ventricular tachyarrhythmias

Angiotensin‐converting enzyme (ACE) inhibitors have been shown to reduce the incidence of mortality following myocardial infarction (MI) and to have beneficial effects on the consequences of MI. Various studies, including several large‐scale trials such as ISIS‐4, GISSI‐3, SAVE, AIRE, and SOLVD, have demonstrated the beneficial effects of ACE inhibitors on mortality and morbidity after both early (up to 48 h post‐MI) and late (weeks to months post‐MI) intervention. Morbidity benefits include reduced incidences of heart failure, unstable angina, and reinfarction, although the latter two effects may not become evident until 9 and 18 months, respectively, after treatment initiation. These effects are independent of dose used, and a class effect of ACE inhibitors seems likely. Finally, a primary advantage of using ACE inhibitors in patients with cardiac disease is shown by the substantial savings which can be achieved, particularly in terms of reduced need for hospitalization for reinfarction, unstable angina and heart failure. In addition to their proven mortality benefits in acute MI, ACE inhibitors reduce heart failure and/or left ventricular dysfunction. Benefit accrues whether treatment is initiated early or late.