(Circulation. 1998;97:2192-2194.)
© 1998 American Heart Association, Inc.
ACE Inhibitors in Acute Myocardial Infarction
Patient Selection and Timing
Marc A. Pfeffer, MD, PhD
From the Cardiovascular Division, Brigham and Women's Hospital,
Harvard Medical School, Boston, Mass.
Correspondence to Dr Pfeffer, 75 Francis St, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
Key Words: Editorials • angiotensin • myocardial infarction
Angiotensin-converting
enzyme inhibitors have earned their place along with
aspirin, ß-blockers, and thrombolytic agents as
medical therapies proven to reduce mortality rates in acute myocardial
infarction.1 The results of well-conducted,
randomized, controlled clinical trials have been so consistent
and so conclusive that the emphasis now shifts from research to
implementation. Because the trials demonstrated that the oral use of an
ACE inhibitor can save lives, the pragmatic questions of
who and when to treat are left to the frontline physicians. Unlike the
clinical trial experience with its protocol-directed inclusion and
exclusion criteria, time window for initiation, and the informed
consent process, the practicing physician must make decisions on the
basis of his or her current assessment of the relative merits as well
as the potential for harm by an ACE inhibitor for
individual patients. Because any further major placebo-controlled
trials of ACE inhibitors in acute myocardial infarction are
not likely, physicians must use the sum of the currently available
information to make the best choices for their
patients.2
The leaders of major trials of
antiplatelet3 and
thrombolytic4 therapies in acute
myocardial infarction have formed collaborative groups that pool their
collective data in an attempt to better understand the safety and
efficacy information of their combined experience. This collaborative
approach goes a step beyond routine meta-analysis because the
group not only attempts to develop more uniform definitions but,
importantly, pools their individual data to derive more reliable
life-table experiences and projections. An ACE
Inhibitor Collaborative Group was convened with these same
. . . [Full Text of this Article]
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