Captopril in acute myocardial infarction: Beneficial effects on infarct size and arrhythmias

Abstract

Summary:It is known from experiments that angiotensinconverting enzyme inhibitors can limit infarct size. In a prospective. randomized, placebo-controlled double-blind study, 22 patients were given 1.5-2.0 mg captoprilh I.V., while 24 patients were given placebo. Medication was started between 2 and I8 h from the onset of infarction. The two groups were matched for age, infarct location, and time of intervention. With the exception of one patient in either group, all were concurrently given nitroglycerin. The necrosis parameters were provided by the quantitative measurement of the QRS complex. The Q wave decreased with captopril treatment (-0.003 mV), but increased with placebo (+0.14 mV, p < 0.05). The number of ventricular premature beats at 24 h from the start of treatment was 2 5 h with placebo, and 9/h with captopril (p < 0.02). Ventricular fibrillation occurred seven times in the placebo group, but did not occur in the captopril group. The creatine kinase infarct weight was 59 gram-equivalents (gEq) with placrebo, and 45 gEq with captopril (p = NS). Mean arterial pressure was reduced by 12 mmHg with captopril treatment. The results show a beneficial effect of captopril on infarct size and electrical instability, over and above the effect of standard management with nitroglycerin and thrombolysis.

Electrocardiographic Changes and Mortality Due to Myocardial Infarction in Rats With or Without Imidapril Treatment

“…In this respect, our findings agree with those obtained with captopril (11,36,37) and ramipril (10), which also significantly reduced the incidence and duration of ventricular fibrillation in isolated rat hearts. In patients, early treatment with captopril (starting 2-18 hours after the onset of symptoms of infarction) also decreased the incidence of PVCs, pathological Q waves, and ventricular fibrillation (38). Ventricular fibrillation was not observed in the infarcted rats.…”

“…5). The ACE inhibitor captopril also reduces the incidence of pathological Q waves after coronary occlusion in rats (41) and humans (38); however, the effects of ACE inhibitors on infarct size are controversial. In this regard, some studies have found no difference between those treated with ACE inhibitors and untreated groups (3,42,43), whereas others have shown a reduction in infarct size (2).…”

More Non-Q-wave Myocardial Infarctions but Similar Infarct Sizes in Patients with Hypertension

“…The infarct reducing effect of ACE inhibitors has previously been described by the current authors and others [30][31][32][33]. Our study has some limitations, and one should be cautious to draw too firm conclusions concerning the results.…”

Angiotensin Ii and Myocardial Infarction

“…В экспериментах на животных ангиотензин II стимулировал развитие атеросклероза на фоне гиперхолестеринемии. Подавление активности РАС путем введения ИАПФ или антагонистов рецепторов ангиотензина II (АРА), напротив, препятствует развитию атеросклероза у животных [19][20][21][22].…”

“…Исследование было прекращено раньше времени из-за явного преиму-Ангиотензин II и инфаркт миокарда Ангиотензин II и инфаркт миокарда щества раннего назначения ИАПФ. Помимо уменьшения размеров ИМ, уменьшалась выраженность ремоделирования левого желудочка; его систолическая функция оказывается лучше, чем при более позднем назначении терапии [20][21][22]43]. Результаты мета-анализа, включавшего более 100000 больных, показали, что ИАПФ по сравнению с плацебо достоверно снижают смертность в течение 30 дней после острого ИМ (7,1% против 7,6%).…”