(Circulation. 2001;103:813.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Effects of Early Use of Atenolol or Captopril on Infarct Size and Ventricular Volume
A Double-Blind Comparison in Patients With Anterior Acute Myocardial Infarction
From Hospital Universitario Virgen de la Arrixaca de Murcia, Spain.
Correspondence to Jose Galcerá-Tomás, Profesor asociado, Unidad de Cuidados Coronarios, Hospital Universitario Virgen de la Arrixaca, 30120 Murcia, Spain. E-mail jgalcera{at}huva.es
Background—
-Blockers
and ACE inhibitors reduce early mortality when either one is started in
the first hours after myocardial infarction (MI). Considering the close
correlation between morphological changes and prognosis, we aimed to
investigate whether the benefit of both -blockers and ACE inhibitors
might reside in a similar protective effect on infarct size or
ventricular volume.
Methods and Results—In a randomized, double-blind comparison between early treatment with captopril or atenolol in 121 patients with acute anterior MI, both drugs showed a similar reduction in mean blood pressure. However, only the atenolol-treated patients showed a significant early reduction in heart rate. Infarct size, obtained from the perfusion defect in resting single photon emission imaging, was higher in captopril-treated patients than in atenolol-treated patients: 29.8±12% versus 20.8±12% (P<0.01) by polar map and 28.3±13% versus 20.0±13% (P<0.01) by tomography. Changes from baseline to 1 week and to 3 months in ventricular end-diastolic volume, assessed by echocardiography, were as follows: 58±14 versus 64±19 (P<0.05) and 65±21 mL/m2 (P<0.05), respectively, with captopril, and 58±18 versus 64±18 (P<0.05) and 69±30 mL/m2 (P<0.05), respectively, with atenolol. Neither group showed significant changes in end-systolic volume. Among patients with perfusion defect >18% (n=51), those treated with atenolol showed a significant increase of end-systolic and end-diastolic ventricular volumes, whereas captopril-treated patients did not.
Conclusions—Although
early treatment with atenolol or captopril results in similar overall
short- and medium-term preservation of ventricular function and
volumes, in patients with larger infarctions, a -blocker alone does
not adequately protect myocardium from ventricular
dilatation.
Key Words: myocardial infarction • remodeling • inhibitors • drugs
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