ATTENUATION OF LEFT-VENTRICULAR DILATATION AFTER ACUTE MYOCARDIAL-INFARCTION BY EARLY INITIATION OF ENALAPRIL THERAPY

This trial investigated the effect of enalapril, administered early, o n left ventricular (LV) volumes after myocardial infarction. Four hund red twenty-eight patients included in the Cooperative New Scandinavian Enalapril Survival Study (CONSENSUS II) were examined with echocardio graphy within 5 days, at 1 month and at 6 months after myocardial infa rction. Enalaprilat (1 mg) or placebo infusion was initiated within 24 hours after infarction, followed by oral treatment to a target dose o f 20 mg/day. A significant attenuation of LV dilatation was noted at 1 month in patients treated with enalapril compared with those receivin g placebo. Changes in LV end-diastolic volume indexes during the first month were (mean +/- SEM) 5.7 +/- 1.0 ml/m2 for the placebo group and 1.9 +/- 0.8 ml/m2 for the enalapril group (p < 0.02). Changes in LV e nd-systolic volume indexes were 3.1 +/- 0.8 and 0.5 +/- 0.6 ml/m2, res pectively (p < 0.02). The between-group difference was most marked in patients with anterior wall infarction (p < 0.005). Volume changes bey ond the first month were similar in both groups but the differences ob served at 1 month were maintained. The larger volumes in the placebo v ersus enalapril group were significant or borderline significant at 1 and 6 months. Thus, enalapril treatment initiated early after myocardi al infarction and continued for 6 months can attenuate LV dilatation d uring the first month resulting in smaller LV volumes after 1 and 6 mo nths.