Effects of imidapril therapy on endogenous fibrinolysis in patients with recent myocardial infarction.
BACKGROUND
Treatment with an angiotensin-converting enzyme (ACE) inhibitor in patients with myocardial infarction has been shown to modify endogenous fibrinolysis.


OBJECTIVE
We investigated the effects of the ACE inhibitor imidapril on endogenous fibrinolysis in association with the serum ACE activity.


METHODS
In a randomized, double-blind, placebo-controlled study beginning 4 weeks after uncomplicated myocardial infarction, 15 patients received imidapril (5 mg daily) (imidapril group) and another 15 received placebo therapy (placebo group) for 4 weeks. Blood sampling was performed before the start of administration and on Days 3, 7, and 28 after the start of administration. Serum ACE activity and plasma fibrinolytic variables [plasminogen activator inhibitor (PAI) activity, plasminogen activator inhibitor type 1 (PAI-1) antigen level, and tissue type plasminogen activator (TPA) antigen level] were measured.


RESULTS
There was no difference between the imidapril and placebo groups in serum ACE activity or plasma fibrinolytic variables before administration. Serum ACE activity decreased significantly on Days 3, 7, and 28 in the imidapril group. The decrease of PAI activity and PAI-1 antigen levels was significantly less on Days 7 and 28, but not on Day 3. The TPA antigen level in the imidapril group was unchanged. None of the parameters in the placebo group was changed.


CONCLUSIONS
The ACE inhibitor imidapril modified fibrinolysis, but the effects occurred after the inhibition of serum ACE activity.
Soejima
H
H
Division of Cardiology, Kumamoto University School of Medicine, Japan.
Ogawa
H
H
Yasue
H
H
Suefuji
H
H
Kaikita
K
K
Nishiyama
K
K
D000284:Administration, Oral; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D000941:Antigens / Q000032:analysis; D015415:Biomarkers / Q000097:blood; D004311:Double-Blind Method; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D048289:Imidazolidines; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy*; D007703:Peptidyl-Dipeptidase A / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood / Q000276:immunology; D010959:Tissue Plasminogen Activator / Q000097:blood / Q000276:immunology; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D000941:Antigens; D015415:Biomarkers; D007093:Imidazoles; D048289:Imidazolidines; D017395:Plasminogen Activator Inhibitor 1; C065166:imidapril; D007703:Peptidyl-Dipeptidase A; D010959:Tissue Plasminogen Activator