Effect of very early angiotensin-converting enzyme inhibition on left ventricular dilation after myocardial infarction in patients receiving thrombolysis: results of a meta-analysis of 845 patients. FAMIS, CAPTIN and CATS Investigators.
OBJECTIVE
We sought to investigate the effect of angiotensin-converting enzyme (ACE) inhibition <9 h after myocardial infarction (MI) on left ventricular (LV) dilation in patients receiving thrombolysis.


BACKGROUND
The ACE inhibitors reduce mortality after MI. Attenuation of LV dilation has been suggested as an important mechanism.


METHODS
The data of 845 patients with three-month echocardiographic follow-up after MI were combined from three randomized, double-blind, placebo-controlled studies. The criteria for these studies included: 1) thrombolytic therapy; 2) ACE inhibition within 6 to 9 h; and 3) evaluation of LV dilation as the primary objective.


RESULTS
The ACE inhibitor was started 3.2+/-1.7 h after the patients' first (mainly, 85%) anterior MI. After three months, LV dilation was not significantly attenuated by very early treatment with an ACE inhibitor. The diastolic volume index was attenuated by 0.5 ml/m2 (95% confidence interval [CI] -1.5 to 2.5, p = 0.61), and the systolic volume index by 0.5 ml/m2 (95% CI -1.0 to 1.9, p = 0.50). Subgroup analysis demonstrated that LV dilation was significantly attenuated by ACE inhibitor treatment for patients in whom reperfusion failed. In contrast, LV dilation was almost unaffected by ACE inhibitor treatment in successfully reperfused patients.


CONCLUSIONS
We could not demonstrate attenuation of LV dilation in patients receiving thrombolysis by ACE inhibitor treatment within 6 to 9 h after MI. We speculate that very early treatment with an ACE inhibitor has a beneficial effect on LV remodeling only in patients in whom reperfusion failed. Other mechanisms may be responsible for the beneficial effects of ACE inhibitors in successfully reperfused patients after MI.
de Kam
P J
PJ
Department of Cardiology, University Hospital, Groningen, The Netherlands.
Voors
A A
AA
van den Berg
M P
MP
van Veldhuisen
D J
DJ
Brouwer
J
J
Crijns
H J
HJ
Borghi
C
C
Ambrosioni
E
E
Hochman
J S
JS
LeJemtel
T H
TH
Kingma
J H
JH
Sutton
M S
MS
van Gilst
W H
WH
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D004108:Dilatation, Pathologic; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000209:etiology
D000806:Angiotensin-Converting Enzyme Inhibitors