When should ACE inhibitors or warfarin be discontinued after myocardial infarction?

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Abstract
The case for ACE inhibition after myocardial infarction appears ironclad. A large meta-analysis established the efficacy of early administration with oral ACE inhibitors in the treatment of unselected patients with acute myocardial infarction.3 A 7% relative reduction in 30 day mortality was observed, with the higher risk subgroups obtaining the greatest benefit. Other studies of patients with symptomatic congestive heart failure or reduced ejection fraction after myocardial infarction have demonstrated a greater relative reduction in mortality (15–25%) in the treated groups.4-6 The SAVE (survival and ventricular enlargement) trial showed a 19% relative reduction in total mortality at the end of follow up in patients with ejection fractions lower than 40% but with no clinical heart failure. The survival advantage was not evident until one year, but the survival curves diverged throughout the remainder of the follow up.7

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