CAPTOPRIL VERSUS DIGOXIN IN PATIENTS WITH CORONARY-ARTERY DISEASE ANDMILD HEART-FAILURE

We conducted a prospective, double-blind, placebo-controlled multicent er trial in order to evaluate the long-term effects of captopril (50 m g/day), digoxin (0.25 mg/day) and placebo on quality of life, cardiova scular events, clinical symptoms and exercise tolerance in patients wi th documented myocardial infarction, resulting in regional wall motion abnormalities, and with mild heart failure (NYHA class II to III with out treatment) and exercise not limited by angina. 222 patients were s tudied, 63 were randomized to captopril, 66 to digoxin, 67 to placebo. Follow-up was conducted for two years. Base line characteristics in t he three treatment groups were similar. After one year of therapy, dig oxin had significantly improved general well-being (p < 0.01 vs captop ril), symptom score (p < 0.05 vs captopril and placebo), and vitality (p < 0.05 vs captopril). Digoxin improved NYHA class in 45% as compare d to placebo (28%, p < 0.05). Worsening of angina was more frequent wi th captopril as compared to digoxin (p < 0.05). However, cardiovascula r events during follow-up were lower in the captopril group as compare d to placebo and digoxin (p < 0.01 captopril vs placebo). No differenc es between groups were observed in baseline and follow-up exercise tol erance between the three groups. Dizziness during upright tilt and cou gh were more frequent with captopril as compared to digoxin or placebo . After two years of follow-up (captopril n = 32, digoxin n = 29, plac ebo n = 27) general well-being was improved with both digoxin and capt opril (p < 0.004 and p < 0.03 vs placebo). In addition, digoxin improv ed vitality, symptom scores, and Minnesota score (p < 0.04, p < 0.01 a nd p < 0.05 vs placebo). We conclude that in patients with coronary ar tery disease, after myocardial infarction and with mild heart failure, digoxin exerted a beneficial effect on several measures of quality of life and improved clinical symptoms. A divergent pattern was observed with captopril, that is, a worsening of angina symptoms early on, par ticularly in patients with multivessel disease, but a remarkable effec t on quality of life, as well as a reduction in cardiovascular events in the longer follow-up of two years.