Chronic
congestive heart failure (CHF) is a common disease responsible for a high mortality and morbidity whose
clinical course can be improved by
angiotensin-converting-enzyme (ACE) inhibition. However, limited data are available on the effects of
ACE inhibitors on the onset and progression of CHF in patients with acute
myocardial infarction (AMI). The present study was performed as a substudy of the Survival of
Myocardial Infarction Long-term Evaluation trial and involved 1,146 patients with anterior wall AMI not undergoing thrombolysis with the exclusion of patients with prior history or clinical signs of CHF on admission. Patients were randomly allocated to treatment with
zofenopril (7.5 to 30 mg twice daily) or placebo for a cumulative period of 6 weeks. The prevalence of CHF, either mild to moderate or severe, has been the main objective and has been evaluated 6 weeks and 1 year after AMI. The overall prevalence of CHF was not reduced by
zofenopril after both 6 weeks and 12 months. Conversely the prevalence of severe CHF (1.6% vs 2.6%: risk reduction 55.5%; 95% confidence interval 9 to 63; p = 0.0325) and the combined occurrence of death or severe CHF (4.8% vs 8.2%: risk reduction 59%; 95% confidence interval 11 to 71; p = 0.024) were reduced after 6 weeks of treatment with
zofenopril. Moreover, the percentage of patients experiencing a deterioration to severe CHF after 1 year was significantly reduced with
zofenopril (11.0% vs 24.3%; p = 0.001). In conclusion, the early administration of
zofenopril to patients with AMI attenuates the progression of the clinical symptoms of CHF and its clinical consequences, suggesting that
ACE inhibitors should be regarded as a suitable strategy for the prevention and treatment of CHF in patients with AMI.