EARLY VERSUS DELAYED ANGIOTENSIN-CONVERTI NG ENZYME-INHIBITION THERAPY IN ACUTE MYOCARDIAL-INFARCTION - THE HEALING AND EARLY AFTERLOAD REDUCING THERAPY (HEART TRIAL)
Ma. Pfeffer et al., EARLY VERSUS DELAYED ANGIOTENSIN-CONVERTI NG ENZYME-INHIBITION THERAPY IN ACUTE MYOCARDIAL-INFARCTION - THE HEALING AND EARLY AFTERLOAD REDUCING THERAPY (HEART TRIAL), Perfusion, 11(3), 1998, pp. 159-168
Background: Although GCE inhibitor therapy has been shown to reduce mo
rtality in patients with acute myocardial infarction (MI), the optimal
dose and the timing of Its initiation have not been determined. Metho
ds and Results: In a double blind trial of 352 patients with anterior
MI, we compared the safety and effectiveness of early (day 1) versus d
elayed (day 14) initiation of the ACE inhibitor ramipril (10 mg) on ec
hocardiographic measures of left,ventricular (LV) area and ejection fr
action (EF), An early, ion-dose ramipril (0.625mg) arm was also evalua
ted,Clinical events did not differ During the first 14 days, the risk
of manifesting a systolic arterial pressure of less than or equal to 9
0 mmHg was increased in both ramipril groups, LVEF increased in all gr
oups during this period, but the early, full-dose ramipril group had t
he greatest improvement in EF (increase: full, 4.9 +/- 10.0%; low, 3.9
+/- 8.2%; delayed, 2.4 +/- 8.8%; p for trend < 0.05) and was the only
group that did not demonstrate a significant increase in LV diastolic
area, Conclusions: The results of the present study demonstrated that
in patients with anterior MI, the early use of ramipril (titrated to
10 mg) attenuated LV remodeling and was associated with a prompter rec
overy of LVEF, The use low-dose regimen did not prevent hypertension a
nd had only intermediate benefits on LV size and function, The more fa
vorable effects on LV topography of the early use of full-dose ramipri
l support the results of the major clinical trials, which have demonst
rated an early survival benefit of ACE inhibition.