A patient with ST-segment elevation myocardial infarction and normal left ventricular function

November 4, 2008
Cardiology Review® Online, December 2006, Volume 23, Issue 12

A 55-year-old man with a history of hypercholesterolemia presented to the emergency department with severe crushing chest pain radiating to the left arm for a duration of 1 hour.

A 55-year-old man with a history of hypercholesterolemia presented to the emergency department with severe crushing chest pain radiating to the left arm for a duration of 1 hour. An electrocardiogram showed ST-segment elevation in the inferior leads.

The patient underwent emergency primary angioplasty with good angiographic results. The ST-segment elevation and symptoms resolved. An echocardiogram the next morning showed normal left ventricular function, with an estimated ejection fraction of 55% and mild inferior hypokinesis.

The patient was discharged with instructions to take aspirin, clopidogrel (Plavix), metoprolol (Lopressor, Toprol XL), and an HMG-CoA reductase inhibitor. Should this patient be receiving an angiotensin-converting enzyme inhibitor? What is the evidence supporting this decision?