What are the benefits of ACE inhibitors in patients with STEMI?
Oral ACE inhibitors reduce fatal and nonfatal major cardiovascular events in patients with STEMI. Their protective effects have been demonstrated independently of the use of other pharmacotherapies (ie, fibrinolytics, aspirin, and beta blockers). The magnitude of clinical benefit is greatest in high-risk patient subgroups (ie, anterior MI, EF 0.40, HF, prior MI, and tachycardia). Demonstration of an early benefit (within the first 24 hours) supports the prompt use of these agents in patients without existing contraindications (hypotension, shock, bilateral renal artery stenosis or history of worsening of renal function with ACE inhibitor/ARB exposure, renal failure, or drug allergy).