Secondary prevention: improving outcomes following myocardial infarction.

In the first five years of the 1990s, the role of angiotensin converting enzyme (ACE) inhibitors in the treatment of patients with myocardial infarction was investigated in a series of large controlled trials involving more than 100 000 patients (table 1). The early use of ACE inhibitors after acute myocardial infarction (MI) has been investigated in four trials (CONSENSUS II, GISSI 3, ISIS 4, and CCS 1) involving more than 98 000 patients with treatment initiated within 24–36 hours from the onset of MI symptoms. Five of the trials (SAVE, AIRE, TRACE, and SOLVD prevention and treatment trials) involving a total of over 11 000 patients investigated the eVects of late treatment with ACE inhibitors in patients with left ventricular dysfunction or failure.