Abstract

Several experimental studies carried out on animals and on isolated heart preparations show that captopril can reduce post-ischemic reperfusion injury. Our study was aimed at investigating the effects of captopril before thrombolysis in acute myocardial infarction (AMI) and included 259 patients, hospitalized within 4 h of the onset of symptoms. Patients were randomly subdivided into two groups: the first group (131 patients, Group A, pretreatment) received 6.25 mg captopril orally about 15 min before i.v. administration of urokinase (2 million), the second group (128 patients, Group B, late-treatment), received captopril about 3 days after thrombolytic treatment. Captopril doses were later increased in both groups according to blood pressure. All patients were subdivided according to the localization of infarction. Anterior AMI was shown by 166 patients (84 from Group A and 82 from Group B); 93 patients showed inferior AMI (47 from Group A and 46 from Group B). Ventricular hyperkinetic arrhythmias (VHAs) due to reperfusion were evaluated during the first 2 h. VHAs occurred in 11.9% of patients with anterior AMI in Group A vs. 37.8% in Group B ( P < 0.001). CK peak normalization time in the group with anterior AMI was achieved after 58 ± 2 h in Group A vs. 71 ± 2 h in Group B ( P < 0.001). CK peak was 1719 ± 152 in Group A vs. 2184 ± 164 U/1 in Group B, ( P < 0.039). Late arrhythmias, higher than Lown's Class 2 were found to occur in 15.4% of patients with anterior AMI of Group A vs. 31.7% in Group B ( P < 0.022), at predischarge Holter test. One-hundred fifty-one patients underwent hemodynamic testing about 3 weeks from AMI. Seventy-seven patients belonged to Group A, 51 with anterior AMI (60%) and 26 with inferior AMI (55.3%), and 74 to Group B, 47 anterior AMIs (57%) and 27 inferior AMIs (58.6%). Ejection fraction and end-systolic volume did not show a statistically significant difference between the two groups. Follow-up (mean, 30.5 ± 2 months) was carried out on 259 patients. There were 131 patients in Group A (84 with anterior AMI and 47 inferior AMI) and 128 in the Group B (82 anterior AMI and 46 inferior AMI). Mortality of patients with anterior AMI was 5.95% in Group A versus 17.07% in Group B ( P < 0.045).

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