Ja. Chiladakis et al., Effects of early captopril therapy after myocardial infarction on the incidence of late potentials, CLIN CARD, 23(2), 2000, pp. 96-102
Background: Late potentials (LP) on signal-averaged electrocardiography (SA
ECG), recorded 6 to 30 days after an acute myocardial infarction (AMI), ide
ntify patients at risk for late arrhythmic events. Angiotensin-converting e
nzyme (ACE) inhibitors have been shown to reduce ventricular remodeling and
cardiovascular mortality after AMI.
Hypothesis: The aim of this study was to investigate the effect of early (<
24 h) administration of captopril on the presence of LP on Days 6-30 after
AMI.
Methods: The study included 117 patients with a first AMI; 63 patients (53
men and 10 women, aged 59 +/- 12 years), 35 with an anterior and 28 with an
inferior AMI (44 thrombolyzed), received early captopril therapy. The cont
rol group consisted of 53 age-matched patients (39 men and 15 women, aged 6
0 +/- 12 years), 19 with an anterior and 35 with an inferior AMI (31 thromb
olyzed, p = NS), who did not receive early therapy with an ACE inhibitor. T
he mean left ventricular ejection fraction was similar in both groups (48 v
s. 46%). Time domain analysis of SAECG was peformed using a band-pass filte
r of 40-250 Hz. Late potentials were considered present if any two of three
criteria were met: (1) Filtered QRS duration (QRSD) > 114 ms, (2) root-mea
n-square voltage of the last 40 ms of the QRS complex (RMS) < 20 mu V, and
(3) duration of low amplitude (< 40 mu V) signal of the terminal portion of
the QRS (LAS) > 38 ms.
Results: In the two groups of patients then were no differences in mean val
ues of SAECG parameters. No patient was receiving any antiarrhythmic drugs.
In the captopril group LPs were present in 9 of 63 patients (14%) and in t
he control group in 17 of 54 patients (31%) (p = 0.046). There was no diffe
rence in the number of patients with a patent infarct-related artery in the
two groups (76 vs. 59%).
Conclusion: Captopril treatment early after an AMI reduces the incidence of
LPs recorded on Days 6-30 and may thus favorably affect the arrhythmogenic
substrate.