ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS IN PREVENTING REMODELING ANDDEVELOPMENT OF HEART-FAILURE AFTER ACUTE MYOCARDIAL-INFARCTION - RESULTS OF THE GERMAN MULTICENTER STUDY OF THE AFFECTS OF CAPTOPRIL ON CARDIOPULMONARY EXERCISE PARAMETERS (ECCE)

Early action of angiotensin-converting enzyme (ACE) inhibitors after m yocardial infarction (MI) has been shown in large scale clinical trial s to reduce mortality over the first weeks. However, the mechanisms in volved are yet unclear and several trials showed a tendency toward a s mall, albeit unexpected, rise in cardiogenic shock or mortality, Since cardiopulmonary exercise testing (CPX) has become a ''gold standard'' in assessing the severity of heart failure, we studied-after finishin g a pilot trial-the effect of captopril versus placebo in 208 patients who were individually titrated (titrated dose, mean 46/69 mg/day afte r 7 days/4 weeks, respectively) in order to preserve their blood press ure in the acute phase of myocardial infarction; we followed the devel opment of congestive heart failure (CHF) over 4 weeks by measuring oxy gen consumption. After 4 weeks, overall oxygen consumption at the anae robic threshold (VO2-AT; 13.7 vs 13.1), maximal oxygen consumption (VO 2max 19.3 vs 18.9 mL/kg per min) and exercise duration (896 vs 839 sec ) showed a, nonsignificant difference in favor of the captopril group, The predefined, categorized, combined endpoint of severe heart failur e or death (heart failure necessitating ACE inhibition, VO2max < 10 mL /kg per min, or death) was significantly reduced in the captopril grou p (n = 7/104) versus placebo (n = 18/104; p = 0.03). Differences were mainly caused by fewer CHF events (Delta n = 10), We conclude that ACE inhibition with individualized dose titration markedly reduces the 4- week incidence of severe heart failure or death; > 10 patients per 100 treated gained major benefits from this therapy. (C) 1997 by Excerpta Medics, Inc.