The combination ace-inhibitors plus canreonate in patients with anterior myocardial infarction: safety and tolerability study

Background: There is recent evidence that aldosterone (ALDO) exerts pro-fib rotic effects, acting via the mineral-corticoid receptors in cardiovascular tissues and partial aldosterone escape during ACE-inhibition treatment occ urs. Methods: A double blind randomised study was performed to evaluate the feasibility, and tolerability of the administration of the 25 mg/day of ca nreonate plus captopril versus captopril alone in patients with anterior AM I unsuitable for thrombolysis and/or not receiving thrombolytic treatment, and unreperfused after thrombolysis. Fifty five patients hospitalised for a nterior AMI,with a serum creatinine concentration <2.0 mg/dl and a serum K concentration <5.0 mmol per liter were randomised in 2 groups: Group A incl uded 27 patients who received captopril and 25 mg i.v. of canreonate (1 mg/ h for the 1st 72 h and then orally 25 mg/day. Group B (28 patients) receive d captopril and placebo. Ten days after admission they underwent echocardio graphy to determine end systolic volume (ESV), ejection fraction (EF), End diastolic diameter EDD, E/A ratio, E deceleration time (dec. time) and isov olumetric relaxation time (IVRT), E and A peak velocities. Results: All pat ients did not show patency of the infarct related artery (7-10 days after A MI) and the 2 groups were similar in regard to age, sex, diabetes, smoking habits, hypertension, CK enzymatic peak, adjuvant therapy, EF, ESV, and inc idence of CABG/PTCA. One patient only showed increase of serum K>5.5 mmol/d l and creatinine >2.0 mg per liter after 10 days of treatment (group A). Th e: mitral EIA ratio was higher in group A than group B (0.85 +/- 0.18 and 0 .75 +/- 0.14) respectively, P = 0.024. Creatinine, blood urea and serum K d id not show significant differences between groups. No side effects were ob served during the study period. The incidence of vessel diseases was simila r in both groups. Conclusions: Our data suggest that the combination of cap topril plus canreonate in feasible in early treatment of AMI patients. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.