ACE-inhibition plus mineralocorticoid antagonism versus ACE-inhibition alone in patients with anterior myocardial infarction

Background. Aldosterone exerts pro-fibrotic effects, acting via mineralo-co rticoid reeptors in cardiovascular tissues. Aldosterone antagonism in combi nation with ACE inhibition may better protect against untoward effects of a ldosterone than ACE inhibition alone. Methods. In a double blind, randomised study the tolerability and efficacy of canreonate (25 mg/day) plus captopril versus captopril alone were evalua ted in 187 patients with an acute anterior myocardial infarction (MI) and a serum creatinine concentration <2.0 mg/dL and a serum K concentration <5.0 mmol/L. Ninety-four patients received captopril and 25 mg canreonate (grou p A). Group B (93 patients) received captopril and placebo. At baseline and at 10 and 90 days after admission Doppler echocardiography was performed. Results. Clinical and demographic aspects were similar in both groups. Also , baseline cardiac enzyme levels, left ventricular (LV) function and incide nce of surgical interventions and angioplasty were comparable. Overall, cre atinine, blood urea and serum K did not show significant differences betwee n groups. However, in 9 patients in group A increases in serum K > 5.5 mmol /dL and creatinine >2.0 mg/L were observed after 10 days of treatment. At 9 0 days, the mitral E/A ratio was higher (p = 0.001) and LV end systolic vol ume smaller (p = 0.021) in patients treated with canreonate than in those r eceiving placebo. No further side effects were observed during the study pe riod. Conclusions. Our data suggest that the combination of captopril plus canreo nate is well tolerated following an acute myocardial infarction and has a b eneficial effect on diastolic and systolic LV parameters and may decrease p ost-MI remodelling.