After myocardial infarction, which medication should be added to the patient's regimen to improve long-term outcomes?

• A. ACE inhibitor
• B. Beta-blocker
• C. Statin
• D. Aspirin

Answer: (A)

After a myocardial infarction, the long-term goal is to prevent adverse remodeling of the ventricle, because remodeling drives progressive heart failure and increases mortality. ACE inhibitors achieve this by blocking the renin-angiotensin-aldosterone system, which otherwise promotes fibrosis, myocyte dilation, and increased wall stress after an infarct. By reducing angiotensin II–mediated remodeling, they limit left ventricular dilation and provide a survival benefit, especially in patients with reduced ejection fraction or LV dysfunction. This mortality reduction has been consistently observed in post‑MI populations, making an ACE inhibitor the most impactful addition to improve long-term outcomes when not contraindicated. While beta-blockers, statins, and antiplatelet therapy are also essential after MI, the targeted effect of ACE inhibitors on remodeling and survival often makes them the best next step in improving prognosis. If there are concerns like kidney issues or hyperkalemia, alternatives such as ARBs can be considered, but the principle remains: blunt remodeling to boost long-term survival.