In the aforementioned randomized trials, maintaining therapy for 2-4 yr will lead to reductions in mortality of 30-70 lives per 1000 patients treated. As suggested by the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines (45,46), ACE inhibitors should be given to all post-MI patients with signs of LV dysfunction with or without symptoms (47). The HOPE trial suggests that all high-risk patients (regardless of whether they experienced MI or LV dysfunction) should receive ACE inhibitors, but these conclusions must be viewed in light of the emerging data from the PEACE trial of patients with prior MI and preserved LV function. Given the totality of current evidence, we recommend the use ACE inhibitors in all patients with prior MI indefinitely, unless results from ongoing trials indicate otherwise. This recommendation includes all post-MI patients regardless of LV function, except in those where there are known contraindications for use.
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