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ACE-Inhibition plus Mineralocorticoid Antagonism versus ACE-inhibition alone in Patients with Anterior Myocardial Infarction

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Abstract

Background. Aldosterone exerts pro-fibrotic effects, acting via mineralo-corticoid reeptors in cardiovascular tissues. Aldosterone antagonism in combination with ACE inhibition may better protect against untoward effects of aldosterone than ACE inhibition alone.

Methods. In a double blind, randomised study the tolerability and efficacy of canreonate (25 mg/day) plus captopril versus captopril alone were evaluated in 187 patients with an acute anterior myocardial infarction (MI) and a serum creatinine concentration <2.0 mg/dL and a serum K concentration <5.0 mmol/L. Ninety-four patients received captopril and 25 mg canreonate (group A). Group B (93 patients) received captopril and placebo. At baseline and at 10 and 90 days after admission Doppler echocardiography was performed.

Results. Clinical and demographic aspects were similar in both groups. Also, baseline cardiac enzyme levels, left ventricular (LV) function and incidence of surgical interventions and angioplasty were comparable. Overall, creatinine, blood urea and serum K did not show significant differences between groups. However, in 9 patients in group A increases in serum K > 5.5 mmol/dL and creatinine >2.0 mg/L were observed after 10 days of treatment. At 90 days, the mitral E/A ratio was higher (p = 0.001) and LV end systolic volume smaller (p = 0.021) in patients treated with canreonate than in those receiving placebo. No further side effects were observed during the study period.

Conclusions. Our data suggest that the combination of captopril plus canreonate is well tolerated following an acute myocardial infarction and has a beneficial effect on diastolic and systolic LV parameters and may decrease post-MI remodelling.

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Authors and Affiliations

  1. Division of Cardiology Paolo Borsellino, G.F. Ingrassia Hospital, Palermo, Italy

    Pietro Di Pasquale, Sergio Cannizzaro, Alfonso Giubilato & Sebastiano Scalzo

  2. Division of Anaesthesiology, Civic Hospital, Palermo, Italy

    Angela Scandurra

  3. Department of Internal Medicine, University of Palermo, Italy

    Salvatore Paterna

Authors
  1. Pietro Di Pasquale
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  2. Sergio Cannizzaro
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  3. Angela Scandurra
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  4. Alfonso Giubilato
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  5. Sebastiano Scalzo
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  6. Salvatore Paterna
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Di Pasquale, P., Cannizzaro, S., Scandurra, A. et al. ACE-Inhibition plus Mineralocorticoid Antagonism versus ACE-inhibition alone in Patients with Anterior Myocardial Infarction. Cardiovasc Drugs Ther 15, 309–314 (2001). https://doi.org/10.1023/A:1012754514127

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