A Cochrane review [Abstract] 1 on effect of early treatment with ACE inhibitors (12 studies, n=84 456), beta-blockers (20), calcium channel blockers (CCBs) (18) and nitrates (18) on short and long-term mortality in patients with an acute cardiovascular event included 65 studies with a total of 166 206 subjects. Immediate ACE inhibitor treatment (started within 24 hours of the onset and lasting for maximum 2 days) was associated with a statistically non-significant reduction in all-cause mortality at 2 days (RR 0.91, 95% CI 0.82 to 1.00; 3 studies, n=77 414) and at 10 days (RR 0.68, 95% CI 0.12 to 3.98; 2 studies, n=145) in acute myocardial infarction. Short-term treatment (started within 24 hours of the onset and lasting for a maximum of 10 days) with ACE inhibitor was associated with a statistically significant reduction in all cause mortality at 10 days as compared to placebo (RR 0.93, 95% CI 0.87 to 0.98; 10 studies, n=84 311). No trial reported mortality at HASH(0x2fd57c0) 30 days.
The 2023 ESC Guidelines for the management of acute coronary syndromes 2 states that ACE inhibitors (or ARBs in cases of intolerance to ACE inhibitors) are recommended in acute coronary syndrome (ACS) patients with heart failure symptoms, LVEF HASH(0x2fd5bc8) 40%, diabetes, hypertension, and/or chronic kidney disease.
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