Effects of early Captopril administration on infarct expansion, left ventricular remodelling and exercise capacity after acute myocardial infarction

Oldroyd, K.G., Pye, M.P., Ray, S.G., Christie, J., Ford, I. , Cobbe, S.M. and Dargie, H.J. (1991) Effects of early Captopril administration on infarct expansion, left ventricular remodelling and exercise capacity after acute myocardial infarction. American Journal of Cardiology, 68(8), pp. 713-718. (doi: 10.1016/0002-9149(91)90641-W)

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Abstract

In a double-blind study, 99 patients (82 men, age range 40 to 75 years) with acute myocardial infarction (AMI) were randomly assigned to receive captopril or placebo. Treatment began within 24 hours of admission. Serial echocardiographic measurements of endocardial segment lengths and left ventricular (LV) volumes, and ejection fractions were obtained. The 2 groups were matched at baseline except for an excess of previous AMI in the placebo group (13 of 50 vs 2 of 49 patients, p = 0.002). The increase in anterior segment length, from baseline to 2 months, was significantly less in the captopril than in the placebo group (2.8 ± 1.6 vs 10.4 ± 2.4mm, 95% confidence interval [CI] −13.5 to −1.7, p = 0.01). The increase in posterior segment length was also less in the captopril group, but the difference was not significant (3.2 ± 1.2 vs 7.0 ± 1.8mm, 95% CI −8.0 to 0.5, p = 0.08). Fewer patients in the captopril group demonstrated increases in segment length >2 standard deviations of the measurement error (14 of 70 [20%] vs 29 of 72 [40%] patients, p = 0.009). In patients with anterior AMI, the infarct-containing anterior segment length increased by 4.5 ± 2.3 mm in the captopril versus 12.4 ± 3.1 mm in the placebo group (95% CI −15.7 to −0.2, p = 0.046), and fewer patients in the captopril group demonstrated infarct expansion (6 of 20 [30%] vs 13 of 21 [62%] patients, p = 0.04). In patients with inferoposterior AMI, the infarct-containing posterior segment length increased by 3.1 ± 1.6 mm in the captopril versus 9.8 ± 2.4 mm in the placebo group (95% CI −13.3 to −0.1, p = 0.046). No significant treatment effects were seen in LV volumes or maximal exercise performance. This study suggests that early treatment with captopril after AMI can attenuate infarct expansion and favorably influence early LV remodeling.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Dargie, Professor Henry and Oldroyd, Dr Keith and Ford, Professor Ian and Cobbe, Professor Stuart
Authors: Oldroyd, K.G., Pye, M.P., Ray, S.G., Christie, J., Ford, I., Cobbe, S.M., and Dargie, H.J.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:American Journal of Cardiology
ISSN:0002-9149

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