Importantly, in vitro studies have shown that enalpril and trandolapril inhibited the CES1-mediated hydrolysis of clopidogrel to the deesterified and inactive metabolite, which was translated into an increased risk of clinically significant bleeding in patients with acute myocardial infarction co-treated with clopidogrel and ACEIs [17]. This evidence concerns the gene CES1 and myocardial infarction.