The Capitol study: A trial of progressive titration of captopril after myocardial infarction with left ventricular dysfunction

The objective of CAPITOL (Captopril Post infarction Tolerance) multicentre open trial was to study the tolerance of a protocol of titration of Captopr il in patients with recent myocardial infarction complicated by left ventri cular dysfunction. Five hundred and four patients, with a mean age of 62 +/- 12 years, were in cluded during the hospital period in the 74 participating intensive care un its, 9 +/- 6 days after myocardial infarction (ejection fraction 34 +/- 6%) . After a 6.25 mg test dose of Captopril, the dosage was progressively incr eased to the target dose of 150 mg at the end of the first month. Of the 50 4 patients included, 343 finished the trail and 161 stopped the trial prema turely. At the end of the hospital period, 73% received 75 mg/day; at the f irst follow-up visit (27 +/- 16 days after inclusion), 59% had attained 150 mg/day, this proportion increasing to 71% at the end of the trial (79 +/- 33 days after inclusion). There was no significant change in blood pressure for the whole study popul ation. However the systolic blood pressure of the patients receiving 150 mg /day of Captopril at the end of the trial was slightly higher than that obs erved at the end of the hospital period (126 +/- 17 mmHg and 116 +/- 17 mmH g respectively, p=0.006). Severe intercurrent events were observed in 89 pa tients : 224 deaths, 7 recurrent infarctions, 58 hospital admissions (21 fo r cardiac failure, 15 for recurrence of vascular accidents, 2 systemic embo li). Of the benign complications, hypotension was observed in 25% of patien ts, nearly half of which occurred during the hospital admission. The drugs prescribed in association with Captopril were Aspirin (78%), betablockers ( 57%), nitrate derivatives (42%) and diuretics (27%). Multivariate analysis showed 3 factors associated with good tolerance of the 150 mg dose of Capto pril : Killip Class I or II on admission, and ejection fraction >30% and an initial systolic blood pressure >100 mmHg. In conclusion, in this trial of dose titration, 3 out of 4 patients with my ocardial infarction and left ventricular dysfunction, tolerated the 150 mg/ day dosage of Captopril. Patients in the trial could also be treated with d rugs recommended after myocardial infarction, in particular the betablocker s.