Hall A S, Ball S G
Department of Medicine, University of Leeds, UK.
J Cardiovasc Risk. 1995 Oct;2(5):396-405. doi: 10.1177/174182679500200503.
The rationale for using angiotensin converting enzyme (ACE) inhibitor therapy after acute myocardial infarction has been largely founded on observations made in experimental situations, and in humans before the routine introduction of reperfusion therapies. An important area of ongoing debate therefore continues to be the role of ACE inhibition as an early adjunct to attempts to achieve and maintain patency of infarct-related coronary arteries. Data from clinical trials indicate a substantial survival benefit in patients with impaired ventricular function, but provide little support for the routine treatment of the remaining majority of patients. An important issue in determining whether these agents should be used in a more general and long-term secondary prevention role, is their potential ability to prevent subsequent reinfarction. However, such a strategy is unlikely to be enhanced by either immediate initiation of treatment or withdrawal after just 1 month of therapy.
急性心肌梗死后使用血管紧张素转换酶（ACE）抑制剂治疗的理论依据，很大程度上基于在实验情况下以及在常规再灌注治疗引入之前对人体的观察。因此，一个仍在持续争论的重要领域是，ACE抑制作为实现和维持梗死相关冠状动脉通畅的早期辅助手段所起的作用。临床试验数据表明，心室功能受损的患者有显著的生存获益，但对于其余大多数患者的常规治疗几乎没有提供支持。在确定这些药物是否应在更广泛的长期二级预防中使用时，一个重要问题是它们预防后续再梗死的潜在能力。然而，无论是立即开始治疗还是仅治疗1个月后停药，都不太可能增强这种策略的效果。
