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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

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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.

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Authors and Affiliations

  1. Department of Cardiology, University Hospital Groningen, The Netherlands

    Adriaan A. Voors (MD, PhD), Pieter J. de Kam, Maarten P. van den Berg, Dirk J. van Veldhuisen & Wiek H. van Gilst

  2. Department of Cardiology, University of Bologna, Italy

    Claudio Borghi

  3. Department of Cardiology, St. Luke’s-Roosevelt Hospital, New York, USA

    Judith S. Hochman

  4. Department of Clinical Pharmacology, University of Groningen, the Netherlands

    Wiek H. van Gilst

  5. Department of Cardiology, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands

    Adriaan A. Voors (MD, PhD)

Authors
  1. Adriaan A. Voors
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  2. Pieter J. de Kam
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  3. Maarten P. van den Berg
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  4. Claudio Borghi
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  5. Judith S. Hochman
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  6. Dirk J. van Veldhuisen
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  7. Wiek H. van Gilst
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Correspondence to Adriaan A. Voors.

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Voors, A.A., de Kam, P.J., van den Berg, M.P. et al. 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. Cardiovasc Drugs Ther 19, 119–124 (2005). https://doi.org/10.1007/s10557-005-0444-9

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  • DOI: https://doi.org/10.1007/s10557-005-0444-9

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