Effect of early treatment with captopril and metoprolol singly and together on postinfarction left ventricular remodeling.
BACKGROUND
beta-Blockers improve clinical outcome after acute myocardial infarction (AMI), but few data are available on their effectiveness in preventing left ventricular remodeling. The aim of the study was to assess the relative effects of captopril, metoprolol, and their combination on left ventricular remodeling after uncomplicated AMI.


METHODS
Two hundred fifty consecutive patients with a first AMI were randomly allocated to receive for 6 months captopril (up to 75 mg/d, group 1), metoprolol (up to 200 mg/d, group 2), or both (group 3) starting within 24 hours from symptom onset. Of these, 130 patients (group 1, 46; group 2, 47; group 3, 37) completed the study; all patients underwent 2-dimensional echocardiography at baseline and after 2 weeks and 3 and 6 months from AMI.


RESULTS
At 6 months, in comparison with baseline values, left ventricular end-diastolic area index (LVEDI) significantly increased in group 3 (P =.013) and wall motion score index significantly decreased in group 1 (P =.038). At any follow-up evaluation, the covariance analysis showed significantly greater interval changes in LVEDI in group 3 than in group 1 (P =.0077 at 2 weeks, P =.0108 at 3 months, and P = 0.0155 at 6 months). No significant differences were observed between group 1 and group 2 and between group 2 and group 3.


CONCLUSIONS
After uncomplicated first AMI, early and long-term treatment with captopril alone attenuates left ventricular remodeling better than its combination with metoprolol. In the head-to-head captopril versus metoprolol therapy strategy comparison, captopril alone seems more effective in reducing postinfarction enlargement, but a definite difference was not demonstrated.
Ricci
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Dipartimento di Cardiologia, Ospedale Santo Spirito, Frascati, Italy. robluc@tiscalinet.it
Coletta
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Pajes
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Putini
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Salustri
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Bottero
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Pasquale
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D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D002216:Captopril / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000187:drug effects*
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002216:Captopril; D008790:Metoprolol