PREVENTIVE TREATMENT OF EARLY HEART-FAILURE AND ASYMPTOMATIC LEFT-VENTRICULAR DYSFUNCTION - ROLE OF ACE-INHIBITORS IN POST MYOCARDIAL-INFARCTION TREATMENT STRATEGIES

Myocardial infarction has become the most important condition causing congestive heart failure. Several treatment regimens compete with each other in the early and later post myocardial infarction phase focussing on different pathophysiologic mechanisms. In this review emphasis is put on absolute risks and absolute risk reductions in patients with left ventricular dysfunction after myocardial infarction. In the first year mortality is still as high as 10% and the major risks are sudden unexpected death, reinfarction, and congestive heart failure. In the following years sudden death and development of congestive heart failure become less prominent, while a considerable risk of reinfarction persists. Thrombolysis and betablockade are the most important drugs in the acute infarction phase leading to a marked reduction in one year mortality. In the first year after infarction betablockade has an established place in the prevention of sudden death; revascularization and aspirin are established in reinfarction prophylaxis. However, since most drugs lower 1 year mortality by 0.5 to 2% only, drugs like ACE inhibitors that influence more than one risk, i.e. sudden death and reinfarction as well as deterioration of pump dysfunction might play a more important role in the therapeutic strategy after myocardial infarction. A supplementation by one or two drugs aiming at the individually estimated leading risks might be the best choice in patients with left ventricular dysfunction today.