Effects of early captopril administration after thrombolysis on regional wall motion in relation to infarct artery blood flow

Objectives. To determine whether early administration of captopril lessens infarct zone regional wall motion abnormalities when infarct artery blood h ow is abnormal. Background. The interaction between angiotensin-converting enzyme (ACE) inh ibitor therapy, ventricular function and infarct artery blood dow has not b een well described. Methods. A total of 493 patients aged less than or equal to 75 years with f irst infarctions, presenting within 4 h of symptom onset, were randomized t o receive 6.25 mg captopril, increasing to 50 mg t.d.s. or a matching place bo 2.1 +/- 0.4 h after commencing intravenous streptokinase (1.5 x 10(6) U over 30 to 60 min). Trial therapy was stopped 48 h prior to angiography at 3 weeks, to determine regional wall motion and infarct artery flow. Results. There were no differences in ejection fractions or end-systolic vo lumes between patients randomized to receive captopril and those randomized to receive a placebo. Among patients with anterior infarction (n = 216), r andomization to captopril resulted in fewer hypokinetic chords (40 +/- 13; vs. 44 +/- 13; p = 0.028) and a trend toward fewer chords >2 SD below norma l (26 +/- 17 vs. 30 +/- 17; p = 0.052) in the infarct zone. In patients ran domized to receive captopril who had anterior infarction and Thrombolysis i n Myocardial Infarction (TIMI) 0-2, flow there were fewer hypokinetic chord s (44 +/- 12 vs. 50 +/- 9; p 0.043) and a trend toward fewer chords >2 SD b elow normal (33 +/- 15 vs. 39 +/- 13; p = 0.057). Patients receiving captop ril who had anterior infarction and corrected TIMI frame counts >27 had few er hypokinetic chords (42 +/- 13 vs. 46 +/- 12; p = 0.015) and fewer chords >2 SD below normal (27 +/- 17 vs. 32 +/- 17; p 0.047). Captopril had no ef fect in patients with inferior infarction. There were 20 late cardiac death s (median follow-up 4 years) in the captopril group and 35 in the placebo g roup (p = 0.036). Conclusions. Randomization to receive captopril 2 h after streptokinase imp roved regional wall motion at 3 weeks. The greatest benefit was seen in pat ients with anterior infarction particularly when infarct artery blood flow is reduced. (C) 1998 by the American College of Cardiology.