Use of ACE inhibitors in patients with STEMI is most beneficial for those with what condition?

The use of ACE inhibitors is particularly beneficial for patients with left ventricular dysfunction following a STEMI (ST-Elevation Myocardial Infarction). These patients often have compromised cardiac output and have a higher risk of complications, including heart failure, due to impaired heart function. ACE inhibitors play a critical role in this context by helping to reduce the workload on the heart and improving hemodynamics. They achieve this through the vasodilation of blood vessels, which decreases systemic vascular resistance, eases left ventricular wall stress, and mitigates the risk of further myocardial injury, remodeling, and progressive heart failure.

In contrast, patients with normal ejection fraction may not derive the same level of benefit since their cardiac function is less likely to be compromised. Similarly, those who have recently undergone surgery may not be appropriate candidates for ACE inhibitors due to concerns about hypotension or operational complications. Patients with low blood pressure might also be at risk if an ACE inhibitor is introduced, as it could potentially exacerbate their hypotensive state. Thus, left ventricular dysfunction is the condition in which the use of ACE inhibitors is most justified and beneficial after a STEMI.