Effects of Two Different ACE Inhibitors, Captopril and Delapril, in the Early Phases of Acute Anterior Myocardial Infarction

Objective: This study was aimed at investigating the effects of captopril or delapril before and just after thrombolysis in acute anterior myocardial infarction (AMI). Patients and Methods: Study participants consisted of 89 patients, hospitalised within 4 hours of the onset of symptoms. Patients were randomly divided into two groups: the first group (45 patients, pretreatment group) received captopril 6.25mg or delapril 7.5mg orally about 15 minutes before intravenous administration of recombinant tissue plasminogen activator (rt-PA) 100mg; the second group (44 patients, late-treatment group) received captopril or delapril about 4 to 6 hours after thrombolytic treatment. Captopril/delapril doses were later increased in both groups according to changes in systolic blood pressure of >100mm Hg. Ventricular arrhythmias (VA) due to reperfusion were evaluated during the first 2 hours. Results: VA occurred in 13 patients receiving pretreatment vs 30 patients receiving late treatment (p = NS). Creatine kinase (CK) peak normalisation time was achieved after 56.6 ± 13 hours (captopril group: 22 patients) and 58 ± 16 hours (delapril group: 23 patients) vs 68 ± 17 hours (captopril: 22 patients) and 70 ± 18 hours (delapril: 22 patients) in the late-treatment group (p < 0.05). CK peak did not show significant differences. Late arrhythmias, Lown’s class >2, occurred in five patients receiving pretreatment vs nine patients receiving late treatment (p = NS), at predischarge Holter test. 86 patients underwent haemodynamic testing about 7 to 10 days after AMI. Ejection fraction did not show any significant difference between all groups, whereas end-systolic volume was statistically reduced in patients receiving pretreatment. Follow-up was carried out on 86 patients. Two patients in the late-treatment group experienced heart failure and one died 6 months after discharge. Conclusion: Our data suggested that captopril and delapril produced similar pharmacodynamic effects in patients with anterior AMI.