Huckell V F, Bernstein V, Crowell R, Dagenais G R, Higginson L A, Isserow S, Laramée P, Liu P, McCans J L, Orchard R C, Prewitt R, Quinn B P, Samson M, Turazza F, Warnica J W, Wielgosz A
Vancouver Hospital, British Columbia.
Can J Cardiol. 1997 Feb;13(2):173-82.
Over the past 10 years, several clinical studies have concluded that, in patients already receiving conventional therapies, angiotensin-converting enzyme (ACE) inhibitors further reduce the risk of death following myocardial infarction (MI). Post-MI ACE inhibitors have proven to be effective as long term therapy in high risk patients as well as when used for much shorter periods in a broad patient population. However, while considerable mortality data have been collected, the effects of ACE inhibitors post-MI on other cardiovascular outcomes have not been as well documented. In addition, a number of issues regarding the most effective use of these agents remain unresolved. This paper, the second of two parts, focuses on the clinical issues and controversies surrounding the use of ACE inhibitors following acute MI. The effects of ACE inhibitors on the outcomes of sudden death, nonsudden death, recurrent angina, mitral regurgitation and left ventricular dysfunction are reviewed and potential mechanisms of action are proposed. In addition, ACE inhibitor therapy is discussed in terms of patient selection criteria, choice of agent, optimal dosing regimen, concomitant use of other therapies and relative costs of treatment. Finally, potential mechanisms of action of ACE inhibitors are proposed for each of the outcomes examined.
在过去10年中，多项临床研究得出结论，对于已经接受传统疗法的患者，血管紧张素转换酶（ACE）抑制剂可进一步降低心肌梗死（MI）后的死亡风险。心肌梗死后使用ACE抑制剂已被证明在高危患者中作为长期治疗有效，并且在广泛的患者群体中使用较短时间时也有效。然而，虽然已经收集了大量的死亡率数据，但心肌梗死后ACE抑制剂对其他心血管结局的影响尚未得到充分记录。此外，关于这些药物最有效使用的一些问题仍未解决。本文是两部分中的第二部分，重点关注急性心肌梗死后使用ACE抑制剂的临床问题和争议。综述了ACE抑制剂对猝死、非猝死、复发性心绞痛、二尖瓣反流和左心室功能障碍结局的影响，并提出了潜在的作用机制。此外，还从患者选择标准、药物选择、最佳给药方案、其他疗法的联合使用以及治疗的相对成本等方面讨论了ACE抑制剂治疗。最后，针对所研究的每种结局提出了ACE抑制剂的潜在作用机制。
