Acute administration of angiotensin converting enzyme inhibitors in thrombolysed myocardial infarction patients is associated with a decreased incidence of heart failure, but an increased re-infarction risk.

Abstract

INTRODUCTION:

Ventricular remodeling starts very early after the onset of an acute myocardial infarction (AMI), and can be prevented by ACE-inhibitors. However, very limited data are available on the effect of acute (< 9 hours) treatment with angiotensin converting enzyme (ACE) inhibitors after an AMI on mortality, heart failure and re-infarction. The aim of the present study was to evaluate the effects of acute ACE-inhibitor treatment.

METHODS:

We performed a pooled analysis of three very similar randomized, placebo-controlled multi-center trials. In 845 thrombolysed patients with mainly first anterior MI, patients were randomised to acute ACE-inhibitor treatment (< 9 hours after MI) or placebo.

RESULTS:

After acute ACE-inhibitor treatment we observed similar 3-months mortality rates, and a significant reduction in the incidence of 3-months heart failure (26.1 vs. 19.3%; RR 0.67; 95% CI 0.45-1.0) as compared to placebo. In contrast, acute ACE-inhibitor treatment was associated with a significant 2.0 times increased 3-months re-infarction risk (7.0 vs. 3.6%; RR 2.0; 95% CI 1.1 to 3.8). Subgroup-analysis showed that patients with small infarct sizes treated with acute ACE-inhibitor (peak CPK < 1000 IU) had a 7.6 times higher re-infarction risk (95% CI 1.7 to 33) than patients with small infarctions treated with placebo.

CONCLUSIONS:

Acute ACE-inhibitor treatment in thrombolysed patients with mainly first anterior AMI resulted in a reduction of heart failure and similar mortality, but an increase in re-infarction rates, especially in patients with small infarct sizes. These results warrant caution for the very early use of ACE-inhibitors in smaller infarctions, although this needs to be confirmed in a larger prospective randomised clinical trial.

• Authors: Adriaan A Voors, Pieter J de Kam, Maarten P van den Berg, Claudio Borghi, Judith S Hochman, Dirk J van Veldhuisen, Wiek H van Gilst
• Journal: Cardiovascular drugs and therapy (Cardiovasc Drugs Ther) Vol. 19 Issue 2 Pg. 119-24 (Mar 2005) ISSN: 0920-3206 [Print] United States
• PMID: 16025230 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Angiotensin-Converting Enzyme Inhibitors
• Fibrinolytic Agents
• Captopril
• Tissue Plasminogen Activator
• Fosinopril

Topics

• Aged
• Angiotensin-Converting Enzyme Inhibitors (administration & dosage)
• Captopril (administration & dosage)
• Female
• Fibrinolytic Agents (therapeutic use)
• Fosinopril (administration & dosage)
• Heart Failure (complications, drug therapy, epidemiology)
• Humans
• Male
• Middle Aged
• Myocardial Infarction (complications, drug therapy, epidemiology)
• Predictive Value of Tests
• Recurrence
• Risk Factors
• Survival Analysis
• Thrombolytic Therapy
• Time Factors
• Tissue Plasminogen Activator (therapeutic use)
• Treatment Outcome