Ball S G
Department of Cardiovascular Studies, University of Leeds, England.
J Cardiovasc Pharmacol. 1993;22 Suppl 9:S18-21.
There is justifiable enthusiasm for the use of angiotensin-converting enzyme (ACE) inhibitors in patients with heart failure. However, early after an acute myocardial infarction, the benefits (or harm) from use of these agents in individual patients may depend on the critical balance between the ischemic problem (the extent of coronary artery narrowing and risk of vessel occlusion) against the need to preserve remaining ventricular function. Patients who are hemodynamically stable without ongoing chest pain but with significantly impaired ventricular function seem likely to gain most from treatment with ACE inhibitors. Extrapolation to the acute infarct situation from the recently published trials in chronic stable heart failure may mislead, and the findings of a number of large ongoing mortality trials in patients with recent myocardial infarction are awaited.
对于心力衰竭患者使用血管紧张素转换酶（ACE）抑制剂，人们有合理的热情。然而，在急性心肌梗死后早期，这些药物在个体患者中的益处（或危害）可能取决于缺血问题（冠状动脉狭窄程度和血管闭塞风险）与保留剩余心室功能需求之间的关键平衡。血流动力学稳定、无持续性胸痛但心室功能明显受损的患者似乎最有可能从ACE抑制剂治疗中获益。从最近发表的慢性稳定心力衰竭试验推断急性梗死情况可能会产生误导，人们正在等待一些针对近期心肌梗死患者的大型死亡率试验的结果。
