USEFULNESS OF ANTIOXIDANT VITAMINS IN SUSPECTED ACUTE MYOCARDIAL-INFARCTION (THE INDIAN EXPERIMENT OF INFARCT SURVIVAL-3)

In a randomized, double-blind, placebo-controlled trial, the effects o f combined treatment with the antioxidant vitamins A 150,000 IU/day), vitamin C (1,000 mg/day), vitamin E (400 mg/day), and beta-carotene 12 5 mg/doy) were compared for 28 days in 63 (intervention group) and 62 (placebo group) patients with suspected acute myocardial infarction. A fter treatment with antioxidants, the mean infarct size (creatine kina se and creatine kinase-MB gram equivalents) was significantly less in the antioxidant group than in the placebo group. Serum glutamic-oxaloa cetic transaminase decreased by 45.6 IU/dl in the antioxidant group ve rsus 25.8 IU/dl in the placebo group (p <0.02). Cardiac enzyme lactate dehydrogenase increased slightly 188.6 IU/dl) in the antioxidant grou p compared with that in the placebo group (166.5 IU/dl) (p <0.01). QRS score in the electrocardiogram was significantly less in the antioxid ant than in the placebo group. The following levels increased in the a ntioxidant group versus the placebo group, respectively: plasma levels of vitamin E increased by 8.8 and 2.2 mu mol/L (p <0.01), vitamin C i ncreased by 12.6 and 4.2 mu mol/L (p <0.01), beta-carotene increased b y 0.28 and 0.06 mu mol/L (p <0.01), and vitamin A increased by 0.36 an d 0.12 mu mol/L (p <0.01), Serum lipid peroxides decreased by 1.22 pmo l/ml in antioxidant versus 0.22 pmol/ml in the placebo group (p <0.01) . Angina pectoris, total arrhythmias, and poor left ventricular functi on occurred less often in the antioxidant group, Cardiac end points we re significantly less in the antioxidant group (20.6% vs 30.6%, respec tively). These results suggest that combined treatment with antioxidan t vitamins A, E, C, and beta-carotene in patients with recent acute my ocardial infarction may be protective against cardiac necrosis be and oxidative stress, and could be beneficial in preventing complications and cardiac event rate in such patients.