在急性心肌梗死患者中，依那普利比氯沙坦更有效地抑制心室重构。

Enalapril suppresses ventricular remodeling more effectively than losartan in patients with acute myocardial infarction.

作者信息

Onodera Hiroyuki, Matsunaga Toshiro, Tamura Yujin, Maeda Naotaka, Higuma Takumi, Sasaki Shingo, Mori Yasuhiro, Yoshimachi Fuminobu, Ishizaka Hiroshi, Hanada Hiroyuki, Osanai Tomohiro, Okumura Ken

机构信息

Second Department of Internal Medicine, Hirosaki University School of Medicine, Hirosaki 036-8562, Japan.

出版信息

Am Heart J. 2005 Oct;150(4):689. doi: 10.1016/j.ahj.2005.03.038.

DOI:10.1016/j.ahj.2005.03.038

PMID:16209966

Abstract

BACKGROUND

Ventricular remodeling after acute myocardial infarction (AMI) is associated with increased morbidity and mortality. ELITE II study showed that losartan, an angiotensin receptor blocker, shows a survival benefit to the same degree as captopril, an angiotensin-converting enzyme inhibitor, does in patients with heart failure. However, recent OPTIMAAL study showed that clinical outcomes after losartan are not superior to those after captopril in patients with AMI. We examined the effect of losartan on ventricular remodeling after AMI comparatively with that of enalapril.

METHODS

We enrolled 203 consecutive patients with AMI (mean age 62 +/- 11 years). All patients underwent primary percutaneous coronary intervention and were randomly assigned to losartan (25-50 mg, n = 101) or enalapril (2.5-10 mg, n = 102) treatment. Biplane left ventriculography was performed just after primary percutaneous transluminal coronary angioplasty (acute phase) and 6 months after the onset of AMI.

RESULTS

Any of the maximal creatine kinase level, left ventricular end-diastolic volume index, end-systolic volume index, and ejection fraction measured at acute phase was not different between losartan and enalapril groups. However, changes in left ventricular end-diastolic index (18 +/- 25 vs 8 +/- 24 mL/m2) and left ventricular end-systolic volume index (10 +/- 20 vs 2 +/- 18 mL/m2) from acute phase to 6 months were significantly greater in losartan than in enalapril group. Change in left ventricular ejection fraction (0.2% +/- 10.3% vs 3.4% +/- 11.6%) from acute phase to 6 months was significantly smaller in losartan than in enalapril group. The plasma level of brain natriuretic peptide at 6 months was significantly higher in losartan than in enalapril group (all P < .05).

CONCLUSION

These indicate that enalapril suppresses ventricular remodeling after AMI more effectively than losartan.

摘要

背景

急性心肌梗死（AMI）后的心室重构与发病率和死亡率增加相关。ELITE II研究表明，血管紧张素受体阻滞剂氯沙坦在心力衰竭患者中显示出与血管紧张素转换酶抑制剂卡托普利相同程度的生存获益。然而，最近的OPTIMAAL研究表明，在AMI患者中，氯沙坦治疗后的临床结局并不优于卡托普利。我们比较了氯沙坦与依那普利对AMI后心室重构的影响。

方法

我们纳入了203例连续的AMI患者（平均年龄62±11岁）。所有患者均接受了直接经皮冠状动脉介入治疗，并被随机分配至氯沙坦组（25 - 50 mg，n = 101）或依那普利组（2.5 - 10 mg，n = 102）进行治疗。在直接经皮腔内冠状动脉成形术后（急性期）以及AMI发病后6个月进行双平面左心室造影。

结果

氯沙坦组和依那普利组在急性期测量的任何一项最大肌酸激酶水平、左心室舒张末期容积指数、收缩末期容积指数和射血分数均无差异。然而，从急性期到6个月，氯沙坦组左心室舒张末期指数（18±25 vs 8±24 mL/m²）和左心室收缩末期容积指数（10±20 vs 2±18 mL/m²）的变化显著大于依那普利组。从急性期到6个月，氯沙坦组左心室射血分数的变化（0.2%±10.3% vs 3.4%±11.6%）显著小于依那普利组。6个月时氯沙坦组脑钠肽的血浆水平显著高于依那普利组（所有P <.05）。