title: Ramipril and Losartan Exert a Similar Long-Term Effect upon Markers of Heart Failure, Endogenous Fibrinolysis, and Platelet Aggregation in Survivors of ST-Elevation Myocardial Infarction: A Single Centre Randomized Trial.
abstract: BACKGROUND
  Blocking the renin-angiotensin-aldosterone system in ST-elevation myocardial infarction (STEMI) patients prevents heart failure and recurrent thrombosis. Our aim was to compare the effects of ramipril and losartan upon the markers of heart failure, endogenous fibrinolysis, and platelet aggregation in STEMI patients over the long term.
  
  
  METHODS
  After primary percutaneous coronary intervention (PPCI), 28 STEMI patients were randomly assigned ramipril and 27 losartan, receiving therapy for six months with dual antiplatelet therapy (DAPT). We measured N-terminal proBNP (NT-proBNP), ejection fraction (EF), plasminogen-activator-inhibitor type 1 (PAI-1), and platelet aggregation by closure times (CT) at the baseline and after six months.
  
  
  RESULTS
  Baseline NT-proBNP ≥ 200 pmol/mL was observed in 48.1% of the patients, EF < 55% in 49.1%, and PAI-1 ≥ 3.5 U/mL in 32.7%. Six-month treatment with ramipril or losartan resulted in a similar effect upon PAI-1, NT-proBNP, EF, and CT levels in survivors of STEMI, but in comparison to control group, receiving DAPT alone, ramipril or losartan treatment with DAPT significantly increased mean CT (226.7 ± 80.3 sec versus 158.1 ± 80.3 sec, p < 0.05).
  
  
  CONCLUSIONS
  Ramipril and losartan exert a similar effect upon markers of heart failure and endogenous fibrinolysis, and, with DAPT, a more efficient antiplatelet effect in long term than DAPT alone.
authors.affiliation: Department of Medical Intensive Care, University Clinical Centre Maribor, Ljubljanska 5, SI-2000 Maribor, Slovenia.
authors.forename: Martin
authors.initials: M
authors.lastname: Marinšek
authors.affiliation: Department of Medical Intensive Care, University Clinical Centre Maribor, Ljubljanska 5, SI-2000 Maribor, Slovenia.
authors.forename: Andreja
authors.initials: A
authors.lastname: Sinkovič
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002317:Cardiovascular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005342:Fibrinolysis / Q000187:drug effects; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D019808:Losartan / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010974:Platelet Aggregation / Q000187:drug effects; D017257:Ramipril / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D019808:Losartan; D017257:Ramipril