Author + information
- Received February 14, 2000
- Revision received July 7, 2000
- Accepted August 24, 2000
- Published online December 1, 2000.
- Pieter J de Kam, MSc∗,
- Adriaan A Voors, MD, PhD†,‡,
- Maarten P van den Berg, MD, PhD∗,
- Dirk J van Veldhuisen, MD, PhD, FACC∗,* (, )
- Jan Brouwer, MD, PhD∗,
- Harry J.G.M Crijns, MD, PhD∗,
- Claudio Borghi, MD§,
- Ettore Ambrosioni, MD§,
- Judith S Hochman, MD∥,
- Thierry H LeJemtel, MD¶,
- Jan-Herre Kingma, MD, PhD†,
- Martin St. John Sutton, MD, MBBS, FACC#,
- Wiek H van Gilst, PhD∗,‡,
- on behalf of the FAMIS CAPTIN and CATS Investigators
- ↵*Reprint requests and correspondence: Dr. D. J. van Veldhuisen, Department of Cardiology/Thoraxcenter, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
We sought to investigate the effect of angiotensin-converting enzyme (ACE) inhibition <9 h after myocardial infarction (MI) on left ventricular (LV) dilation in patients receiving thrombolysis.
The ACE inhibitors reduce mortality after MI. Attenuation of LV dilation has been suggested as an important mechanism.
The data of 845 patients with three-month echocardiographic follow-up after MI were combined from three randomized, double-blind, placebo-controlled studies. The criteria for these studies included: 1) thrombolytic therapy; 2) ACE inhibition within 6 to 9 h; and 3) evaluation of LV dilation as the primary objective.
The ACE inhibitor was started 3.2 ± 1.7 h after the patients’ first (mainly, 85%) anterior MI. After three months, LV dilation was not significantly attenuated by very early treatment with an ACE inhibitor. The diastolic volume index was attenuated by 0.5 ml/m2 (95% confidence interval [CI] −1.5 to 2.5, p = 0.61), and the systolic volume index by 0.5 ml/m2 (95% CI −1.0 to 1.9, p = 0.50). Subgroup analysis demonstrated that LV dilation was significantly attenuated by ACE inhibitor treatment for patients in whom reperfusion failed. In contrast, LV dilation was almost unaffected by ACE inhibitor treatment in successfully reperfused patients.
We could not demonstrate attenuation of LV dilation in patients receiving thrombolysis by ACE inhibitor treatment within 6 to 9 h after MI. We speculate that very early treatment with an ACE inhibitor has a beneficial effect on LV remodeling only in patients in whom reperfusion failed. Other mechanisms may be responsible for the beneficial effects of ACE inhibitors in successfully reperfused patients after MI.
☆ The three studies on which this meta-analysis was based (CATS, FAMIS and CAPTIN) were all financially supported by Bristol-Myers Squibb.
- Received February 14, 2000.
- Revision received July 7, 2000.
- Accepted August 24, 2000.
- American College of Cardiology