Cardiovascular Drugs and Therapy

, Volume 19, Issue 2, pp 119–124

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

  • 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
Clinical Trials

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.

Key Words

myocardial infarction mortality morbidity pooled-analysis reperfusion angiotensin-converting enzyme inhibitor 

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Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Adriaan A. Voors
    • 1
    • 5
  • Pieter J. de Kam
    • 1
  • Maarten P. van den Berg
    • 1
  • Claudio Borghi
    • 2
  • Judith S. Hochman
    • 3
  • Dirk J. van Veldhuisen
    • 1
  • Wiek H. van Gilst
    • 1
    • 4
  1. 1.Department of CardiologyUniversity Hospital GroningenThe Netherlands
  2. 2.Department of CardiologyUniversity of BolognaItaly
  3. 3.Department of CardiologySt. Luke’s-Roosevelt HospitalUSA
  4. 4.Department of Clinical PharmacologyUniversity of Groningenthe Netherlands
  5. 5.Department of CardiologyUniversity Hospital GroningenThe Netherlands

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