ACE-inhibition plus mineralocorticoid antagonism versus ACE-inhibition alone in patients with anterior myocardial infarction.
BACKGROUND
Aldosterone exerts pro-fibrotic effects, acting via mineralo-corticoid reeptors in cardiovascular tissues. Aldosterone antagonism in combination with ACE inhibition may better protect against untoward effects of aldosterone than ACE inhibition alone.


METHODS
In a double blind, randomised study the tolerability and efficacy of canreonate (25 mg/day) plus captopril versus captopril alone were evaluated in 187 patients with an acute anterior myocardial infarction (MI) and a serum creatinine concentration <2.0 mg/dL and a serum K concentration <5.0 mmol/L. Ninety-four patients received captopril and 25 mg canreonate (group A). Group B (93 patients) received captopril and placebo. At baseline and at 10 and 90 days after admission Doppler echocardiography was performed.


RESULTS
Clinical and demographic aspects were similar in both groups. Also, baseline cardiac enzyme levels, left ventricular (LV) function and incidence of surgical interventions and angioplasty were comparable. Overall, creatinine, blood urea and serum K did not show significant differences between groups. However, in 9 patients in group A increases in serum K >5.5 mmol/dL and creatinine >2.0 mg/L were observed after 10 days of treatment. At 90 days, the mitral E/A ratio was higher (p = 0.001) and LV end systolic volume smaller (p = 0.021) inpatients treated with canreonate than in those receiving placebo. No further side effects were observed during the study period.


CONCLUSIONS
Our data suggest that the combination of captopril plus canreonate is well tolerated following an acute myocardial infarction and has a beneficial effect on diastolic and systolic LV parameters and may decrease post-MI remodelling.
Di Pasquale
P
P
Division of Cardiology Paolo Borsellino, G.F. Ingrassia Hospital, Palermo, Italy. LEHDi@Tin.iT
Cannizzaro
S
S
Scandurra
A
A
Giubilato
A
A
Scalzo
S
S
Paterna
S
S
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002191:Canrenoic Acid / Q000627:therapeutic use*; D002216:Captopril / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000188:drug therapy*; D015425:Myocardial Reperfusion / Q000379:methods
D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D002191:Canrenoic Acid; D002216:Captopril