ST elevation myocardial infarction inhibition of the renin-angiotensin-aldosterone system at discharge
| Myocardial infarction | |
| ICD-10 | I21-I22 |
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| ICD-9 | 410 |
| DiseasesDB | 8664 |
| MedlinePlus | 000195 |
| eMedicine | med/1567 emerg/327 ped/2520 |
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Angiotensin Converting Enzyme Inhibition
Aldosterone Blockade
Data regarding the safety and efficacy aldosterone inhibition comes from those trials of heart failure that enrolled pateints with a prior MI.
Guidelines (Do not edit)
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Class I 1. An ACE inhibitor should be administered orally during convalescence from STEMI in patients who tolerate this class of medication, and it should be continued over the long term. (Level of Evidence: A) 2. An ARB should be administered to STEMI patients who are intolerant of ACE inhibitors and have either clinical or radiological signs of heart failure or LVEF less than 0.40. Valsartan and candesartan have demonstrated efficacy for this recommendation. (Level of Evidence: B) 3. Long-term aldosterone blockade should be prescribed for post-STEMI patients without significant renal dysfunction (creatinine should be less than or equal to 2.5 mg/dL in men and less than or equal to 2.0 mg/dL in women) or hyperkalemia (potassium should be less than or equal to 5.0 mEq/L) who are already receiving therapeutic doses of an ACE inhibitor, have an LVEF of less than or equal to 0.40, and have either symptomatic heart failure or diabetes. (Level of Evidence: A) Class IIa In STEMI patients who tolerate ACE inhibitors, an ARB can be useful as an alternative provided there are either clinical or radiological signs of heart failure or LVEF is less than 0.40. Valsartan and candesartan have established efficacy for this recommendation. (Level of Evidence: B)
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