EFFECTS OF CAPTOPRIL ON MORTALITY AND MOR BIDITY RATES IN PATIENTS WITH LEFT-VENTRICULAR DYSFUNCTION FOLLOWING MYOCARDIAL-INFARCTION - RESULTS OF SURVIVAL AND VENTRICULAR HYPERTROPHIC STUDIES

Left ventricular dilation and dysfunction after myocardial infarction are major predictors of death. In experimental and clinical studies, l ong-term therapy with captopril, an angiotension-converting enzyme inh ibitor, decreased ventricular dilation and rearrangement. This study w as undertaken to examine whether captopril may reduce morbidity and mo rtality in patients with left ventricular dysfunction following myocar dial infarction. On days 3 to 16 after myocardial infarction, 2231 pat ients with <40% ejection fraction, but without signs of obvious heart failure ot symptoms of myocardial ischemia were studied in a double-bl ind study, of them 1116 took placebo and 1115 had captopril. The follo w-up averaged 42 months. The mortabity due to any causes was significa ntly lower in the captopril group (228 deaths or 20% than in the place bo group (275 deaths or 21%). The decrease in the risk was 19 percent (95 percent confidence interval, 3 to 32 percent; p=0.019). The incide nce of fatal and grave nonfatal cardiovascular events significantly de creased in captopril-treated patients. The risk decrease was 21 percen t (95 percent confidence interval, 5 to 35 percent; p=0.014) for cardi ovascular mortality; 37 percent (95 percent confidence interval, 20 to 50 percent; p<0.001) for the development of severe heart failure; 22 percent (95 percent confidence, 4 to 37 percent, p=0.019) for congesti ve heart failure requiring hospitalization; 25 percent (95 percent con fidence interval, 5 to 40 percent; p=0.015) for recurrent myocardial i nfarction. Thus, long-term captopril use in patients with asymptomatic left ventricular dysfunction following prior myocardial infarction re sulted in survival improvement and decreased morbidity and mortality d ue to severe cardiovascular events. There were positive results both i n patients treated with thrombolytics, aspirin or <$Ebeta>-blockers an d in those untreated with the above drugs. This suggests that the use of captopril additionally improved the therapeutic outcomes in patient s with prior myocardial infection.