The design and main results of the OPTIMAAL trial have been reported [15,16]. In
brief, 5477 patients, 50 years or older, with AMI complicated with heart HF during
the acute phase were randomly assigned to a target dose of losartan (50 mg OD) or
captopril (50 mg TID) as tolerated. HF was suggested by: an ejection fraction (EF)
of less than 35% or a left-ventricular (LV) end-diastolic dimension of greater than
65 mm (optional) and/or a new Q-wave anterior-wall AMI, or any reinfarction with
previous pathological Q-waves in the anterior wall and/or HF symptoms by one or
more of the following: treatment with diuretic or intravenous vasodilator therapy for
HF, pulmonary rales, third heart sound, persistent sinus tachycardia (.100 beats/
min), or radiographic evidence of pulmonary congestion. Patients were enrolled within
10 days of the onset of symptoms.