EARLY VERSUS DELAYED ANGIOTENSIN-CONVERTI NG ENZYME-INHIBITION THERAPY IN ACUTE MYOCARDIAL-INFARCTION - THE HEALING AND EARLY AFTERLOAD REDUCING THERAPY (HEART TRIAL)

Citation
Ma. Pfeffer et al., EARLY VERSUS DELAYED ANGIOTENSIN-CONVERTI NG ENZYME-INHIBITION THERAPY IN ACUTE MYOCARDIAL-INFARCTION - THE HEALING AND EARLY AFTERLOAD REDUCING THERAPY (HEART TRIAL), Perfusion, 11(3), 1998, pp. 159-168
Citations number
41
Language
TEDESCO
art.tipo
Article
Categorie Soggetti
Peripheal Vascular Diseas
Journal title
ISSN journal
0935-0020
Volume
11
Issue
3
Year of publication
1998
Pages
159 - 168
Database
ISI
SICI code
0935-0020(1998)11:3<159:EVDANE>2.0.ZU;2-2
Abstract
Background: Although GCE inhibitor therapy has been shown to reduce mo rtality in patients with acute myocardial infarction (MI), the optimal dose and the timing of Its initiation have not been determined. Metho ds and Results: In a double blind trial of 352 patients with anterior MI, we compared the safety and effectiveness of early (day 1) versus d elayed (day 14) initiation of the ACE inhibitor ramipril (10 mg) on ec hocardiographic measures of left,ventricular (LV) area and ejection fr action (EF), An early, ion-dose ramipril (0.625mg) arm was also evalua ted,Clinical events did not differ During the first 14 days, the risk of manifesting a systolic arterial pressure of less than or equal to 9 0 mmHg was increased in both ramipril groups, LVEF increased in all gr oups during this period, but the early, full-dose ramipril group had t he greatest improvement in EF (increase: full, 4.9 +/- 10.0%; low, 3.9 +/- 8.2%; delayed, 2.4 +/- 8.8%; p for trend < 0.05) and was the only group that did not demonstrate a significant increase in LV diastolic area, Conclusions: The results of the present study demonstrated that in patients with anterior MI, the early use of ramipril (titrated to 10 mg) attenuated LV remodeling and was associated with a prompter rec overy of LVEF, The use low-dose regimen did not prevent hypertension a nd had only intermediate benefits on LV size and function, The more fa vorable effects on LV topography of the early use of full-dose ramipri l support the results of the major clinical trials, which have demonst rated an early survival benefit of ACE inhibition.