How to use ACE-inhibitors, β-blockers, and newer therapies in AMI, ,

Besides reperfusion treatment, which is the most powerful approach to the underlying pathophysiological cause of myocardial infarction, adjunctive therapies should be considered to reduce clinical symptoms, and improve left ventricular function and mortality rates. Randomized clinical trials and overviews of adjunctive therapy with β-blockers and angiotensin-converting enzyme (ACE) inhibitors showed that these treatments may further reduce mortality rates by approximately 10%. On the basis of this evidence, guidelines suggest that (1) all patients with acute myocardial infarction who do not have clear contraindications should be treated within 24 hours from the onset of symptoms with intravenous β-blockers. If tolerated, the treatment should be continued for at least 2 to 3 years and perhaps longer; (2) ACE inhibitor treatment should be started during the first day after myocardial infarction in most patients after timely and careful observation of the patient’s hemodynamic and clinical status and after administration of routinely recommended treatments (thrombolysis, aspirin, and β-blockers). In the patients showing neither clinical symptoms nor instrumental signs of left ventricular dysfunction, ACE inhibitor treatment can be stopped at the time of hospital discharge and ventricular function reevaluated after an adequate period of time. (Am Heart J 1999;138:S183-S187.)