Effects of two different ACE inhibitors, captopril and delapril, in the early phases of acute anterior myocardial infarction

Objective: This study was aimed at investigating the effects of captopril o r delapril before and just after thrombolysis in acute anterior myocardial infarction (AMI). Patients and Methods: Study participants consisted of 89 patients, hospital ised within 4 hours of the onset of symptoms. Patients were randomly divide d into two groups: the first group (45 patients, pretreatment group) receiv ed captopril 6.25mg or delapril 7.5mg orally about 15 minutes before intrav enous administration of recombinant tissue plasminogen activator (rt-PA) 10 0mg; the second group (44 patients, late-treatment group) received captopri l or delapril about 4 to 6 hours after thrombolytic treatment. Captopril/de lapril doses were later increased in both groups according to changes in sy stolic blood pressure of >100mm Hg. Ventricular arrhythmias (VA) due to rep erfusion were evaluated during the first 2 hours. Results: VA occurred in 13 patients receiving pretreatment vs 30 patients r eceiving late treatment (p = NS). Creatine kinase (CK) peak normalisation t ime was achieved after 56.6 +/- 13 hours (captopril group: 22 patients) and 58 +/- 16 hours (delapril group: 23 patients) vs 68 +/- 17 hours (captopri l: 22 patients) and 70 +/- 18 hours (delapril: 22 patients) in the late-tre atment group (p < 0.05). CK peak did not show significant differences. Late arrhythmias, Lown's class >2, occurred in five patients receiving pretreat ment vs nine patients receiving late treatment (p = NS), at predischarge Ho lter rest. 86 patients underwent haemodynamic testing about 7 to 10 days af ter AMI. Ejection fraction did not show any significant difference between all groups, whereas end-systolic volume was statistically reduced in patien ts receiving pretreatment. Follow-up was carried out on 86 patients. Two pa tients in the late-treatment group experienced heart failure and one died 6 months after discharge. Conclusion: Our data suggested that captopril and delapril produced similar pharmacodynamic effects in patients With anterior AMI.