In this review, we evaluate the efficacy of ACE-inhibitors for the treatment of acute myocardial infarction (AMI). Our information is based on published material and personal experience derived from extensive revision of the SMILE study. All trials with a randomized experimental design, irrespective of their primary research objective, have been included. Results are presented in terms of either hemodynamic or clinical benefit. The available evidence indicates that the mortality rate of AMI patients who undergo short- and long-term treatment with ACE-inhibitors is significantly reduced. This reduction is more evident in high risk patients, such as subjects with asymptomatic left ventricular dysfunction, congestive heart failure on admission, anterior location of the infarction. ACE-inhibitors also limit the development and progression of congestive heart failure after myocardial infarction, the onset of clinical manifestations of coronary artery disease (reinfarction, need for revascularization) and the occurrence of ventricular arrhythmias, probably by means of mechanisms involving a specific effect of these compounds. In conclusion, the available data indicate that administration of ACE-inhibitors to patients with AMI is associated with significant clinical benefit.