title: 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.
abstract: BACKGROUND
  beta-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 beta-blockers and ACE inhibitors might reside in a similar protective effect on infarct size or ventricular volume.
  
  
  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/m(2) (P<0.05), respectively, with captopril, and 58+/-18 versus 64+/-18 (P<0.05) and 69+/-30 mL/m(2) (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 beta-blocker alone does not adequately protect myocardium from ventricular dilatation.
authors.affiliation: Hospital Universitario Virgen de la Arrixaca de Murcia, Spain. jgalcera@huva.es
authors.forename: J
authors.initials: J
authors.lastname: Galcerá-Tomás
authors.forename: F J
authors.initials: FJ
authors.lastname: Castillo-Soria
authors.forename: M M
authors.initials: MM
authors.lastname: Villegas-García
authors.forename: R
authors.initials: R
authors.lastname: Florenciano-Sánchez
authors.forename: J G
authors.initials: JG
authors.lastname: Sánchez-Villanueva
authors.forename: J A
authors.initials: JA
authors.lastname: de La Rosa
authors.forename: A
authors.initials: A
authors.lastname: Martínez-Caballero
authors.forename: J A
authors.initials: JA
authors.lastname: Valentí-Aldeguer
authors.forename: P
authors.initials: P
authors.lastname: Jara-Pérez
authors.forename: M
authors.initials: M
authors.lastname: Párraga-Ramírez
authors.forename: I
authors.initials: I
authors.lastname: López-Martínez
authors.forename: L
authors.initials: L
authors.lastname: Iñigo-García
authors.forename: F
authors.initials: F
authors.lastname: Picó-Aracil
mesh_terms: D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D001794:Blood Pressure; D002216:Captopril / Q000627:therapeutic use*; D017023:Coronary Angiography; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000187:drug effects* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology; D011446:Prospective Studies; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon; D016276:Ventricular Function / Q000187:drug effects*
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001262:Atenolol; D002216:Captopril