[Angiotensin converting enzyme inhibitors in acute period of myocardial infarction: the place of zofenopril].

Acute myocardial infarction (MI) is one of main predecessors of chronic heart failure (CHF), for the treatment of which angiotensin converting enzyme inhibitors (ACEI) are recommended at present. It seems logical to prescribe ACEI in early period of MI in order to prevent development of CHF in postinfarction period. For assessment of benefit and risk related to prescription of ACEI early after onset of acute MI multiple placebo controlled trials have been carried out. Data obtained in these trials evidence for inexpediency of wide use of ACEI in acute period of MI. Several categories of patients with acute MI with stable hemodynamics have been established in whom benefit of early prescription of ACEI noticeably outweighs possible risk. Those are patients with clinical manifestations of CHF or echocardiographical signs of systolic left ventricular dysfunction as well as patients with high risk of development of CHF in postinfarction period. The latter group comprises patients with transmural MI of the anterior left ventricular wall in whom thrombolytic therapy either have not been carried out or have been ineffective, patients with diabetes mellitus or hypertension in anamnesis. In all other cases prescription of ACEI in early period of acute MI might be dangerous because hypotension induced by them can worsen blood flow and aggravate ischemic injury of the myocardium and increase dimensions of MI.