DOES CAPTOPRIL TREATMENT BEFORE THROMBOLYSIS IN ACUTE MYOCARDIAL-INFARCTION ATTENUATE REPERFUSION DAMAGE SHORT-TERM AND LONG-TERM EFFECTS

Several experimental studies carried out on animals and on isolated he art preparations show that captopril can reduce post-ischemic reperfus ion injury. Our study was aimed at investigating the effects of captop ril before thrombolysis in acute myocardial infarction (AMI) and inclu ded 259 patients, hospitalized within 4 h of the onset of symptoms. Pa tients were randomly subdivided into two groups: the first group (131 patients, Group A, pretreatment) received 6.25 mg captopril orally abo ut 15 min before i.v. administration of urokinase (2 million), the sec ond group (128 patients, Group B, late-treatment), received captopril about 3 days after thrombolytic treatment. Captopril doses were later increased in both groups according to blood pressure. All patients wer e subdivided according to the localization of infarction. Anterior AMI was shown by 166 patients (84 from Group A and 82 from Group B); 93 p atients showed inferior AMI (47 from Group A and 46 from Group B). Ven tricular hyperkinetic arrhythmias (VHAs) due to reperfusion were evalu ated during the first 2 h. VHAs occurred in 11.9% of patients with ant erior AMI in Group A vs. 37.8% in Group B (P < 0.001). CK peak normali zation time in the group with anterior AMI was achieved after 58 +/- 2 h in Group A vs. 71 +/- 2 h in Group B (P < 0.001). CK peak was 1719 +/- 152 in Group A vs. 2184 +/- 164 U/1 in Group B, (P < 0.039). Late arrhythmias, higher than Lown's Class 2 were found to occur in 15.4% o f patients with anterior AMI of Group A vs. 31.7% in Group B (P < 0.02 2), at predischarge Holter test. One-hundred fifty-one patients underw ent hemodynamic testing about 3 weeks from AMI. Seventy-seven patients belonged to Group A, 51 with anterior AMI (60%) and 26 with inferior AMI (55.3%), and 74 to Group B, 47 anterior AMIs (57%) and 27 inferior AMIs (58.6%). Ejection fraction and end-systolic volume did not show a statistically significant difference between the two groups. Follow- up (mean, 30.5 +/- 2 months) was carried out on 259 patients. There we re 131 patients in Group A (84 with anterior AMI and 47 inferior AMI) and 128 in the Group B (82 anterior AMI and 46 inferior AMI). Mortalit y of patients with anterior AMI was 5.95% in Group A versus 17.07% in Group B (P < 0.045.