Abstract 12141: Imidapril Attenuates Matrix Metalloproteinase-9 Activity More Efficiently than Losartan in Patients with Acute Myocardial Infarction
Background: LV remodeling after acute myocardial infarction (AMI) is an important prognostic factor. Renin-angiotensin system is critically involved in this process and its inhibitors, e.g., angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), are broadly used. Recent in vivo studies suggest that ACEI might bring greater inhibitory effect against LV remodeling after AMI as compared with ARB through its direct inhibition of activity of matrix metalloproteinase (MMP), especially MMP−9. However, clinical evidence has been sparse.
Hypothesis: We assessed the hypothesis that ACEI might attenuate MMP-9 activity and LV remodeling more efficiently than ARB in patients with AMI in the clinical setting.
Methods and Results: Consecutive 111 patients (62.5 y.o., male 82%) with first AMI who underwent successful PCI were randomized within 24 hrs to treat with ACEI (imidapril) or ARB (losartan) for 3 months. Baseline background did not differ between 2 groups. Serum MMP-9 activity, a primary endpoint, did not differ between 2 groups at day 0 but it was significantly lower in ACEI group than ARB group since day 3 until 3 months (Figure). LVgram at day 0 and 3 months revealed that LVEF increased in both groups but its improvement at 3 months was significantly greater in ACEI group than ARB group (9.4 ± 1.6 in ACEI vs. 5.2 ± 1.7 % in ARB, p=0.039). Changes in plasma BNP from day 0 to 3 months were markedly depressed in ACEI group as compared with ARB group (−15 ± 20 vs. 43 ± 22 pg/mL, respectively, p=0.025). We used multivariable logistic regression analysis for changes in serum MMP-9 level from baseline (ΔMMP-9 level). ACEI administration was independently associated with the lowest tertile of ΔMMP-9 level (adjusted odds ratio, 3.34; 95% CI, 1.40 to 8.58).
Conclusions: Imidapril attenuates serum MMP level more efficiently after AMI with better LVEF improvement and lower BNP level than losartan in the clinical setting.
- © 2010 by American Heart Association, Inc.