The study was designed to examine the safety and efficacy of acute interventional use of
captopril on left ventricular volumes, ventricular arrhythmias and
neurohormones during thrombolysis in patients with a first anterior
myocardial infarction, within 6 h of onset of symptoms.
Left ventricular dysfunction and prognosis after
myocardial infarction can be improved by
angiotensin converting enzyme inhibition started after the ischaemic phase. Experimental evidence suggests that intervention during thrombolysis may lead to even further benefit. In a randomized, double-blind placebo-controlled trial, 298 patients with a first anterior
myocardial infarction, eligible for
thrombolytic therapy were treated with
captopril 6.25 mg or placebo, started immediately upon
streptokinase infusion and titrated to 25 mg t.i.d.. The efficacy of
captopril by an intention-to-treat-analysis to reduce left ventricular volumes, ventricular arrhythmias, neurohumoral activation and enzymatic
infarct size was measured. During dose titration, mean blood pressure and heart rate were similar in both groups. However,
hypotension after the first dose was reported in 18 patients on placebo and 31 patients on
captopril (P < 0.05). At discharge, 80% of patients were on study medication. Left ventricular volumes were significantly increased in both groups at 3 months, but they tended to be lower in the
captopril group; however, the differences were not statistically significant. The incidence of
accelerated idioventricular rhythm and non-sustained
ventricular tachycardia in
captopril patients was lower than in placebo patients (P < 0.05), parallelled by transiently lower
norepinephrine levels (P < 0.05) upon thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)