707-1 Short-term ACE-Inhibition and Onset and Progression of Congestive Heart Failure in Patients with Acute Myocardial Infarction

Abstract

Anterior acute myocardial infarction (AMI) is often complicated by clinical signs of CHI. We report the data of 1146 patients with anterior A.M.I. without previous history or clinical signs of CHF on admission and enrolled under the SMILE study. Patients were randomly allocated to a 6-week double blind treatment with placebo (P) or zofenopril (Z) and then followed-up for 1 year. Baseline demographic characteristics were similar in Z and P group who were comparable for blood pressure, ECG pattern, peak CPK, and concomitant drug treatment. After 6 weeks the cumulative occurrence of CHF was not different in Z and P groups (13.3% vs 13.9%; P = 0.234). Clinical signs of mild to moderate CHF were present in 11.7% ofthe Z population and 10.2% of the P group (P = 0.178) whereas severe refractory CHF occurred significantly less in Z (1.6%) compared to P (3.6%) patients (RR = 2.3: C.I. 95% 1–3.3: p = 0.0328). After 1 year the overall occurrence of CHF was 14.8% in P and 15.4% in Z treated patients. NYHA class I was more common among Z treated patients (8.2% vs 1.5%; P = 0.021) whereas the percentage of patients in NYHA class IV was higher in P treated patients (24.3% vs 11.0%; p = 0.001). In conclusion the early and long-term development and progression of CHF can be prevented by short-term administration of zofenopril in patients with acute myocardial infarction.