Suşan Monica, Petrescu L, Riviş A I, Suşan R M, Burghină D, Dan Rodica, Cozma D, Drăgulescu S I
Internal Medicine I Department, City Hospital, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania.
Rom J Intern Med. 2005;43(3-4):187-98.
The activation of the renin-angiotensin system (RAS) is a major determinant of ventricular remodeling. We prospectively assessed whether the dual RAS blockade (angiotensin II AT 1-receptor blocker and angiotensin-converting enzyme inhibitor therapy) in patients with acute myocardial infarction (AMI) who were treated by primary percutaneous coronary intervention (PCI) and stenting provides benefit on the improvement of the left ventricle function. A secondary aim is to demonstrate that triple therapy with angiotensin-converting enzyme (ACE) inhibitors, angiotensin II AT 1-receptor blockers (ARBs) and beta blockers does not increase cardiovascular morbidity, cardiovascular mortality and all cause mortality.
We investigated 44 patients with AMI with ST elevation undergoing primary PCI and stenting. All patients received standard therapy including an ACE inhibitor and a beta blocker. We divided the patients into two groups, A and B. Valsartan was added to the standard therapy within the first 6 hours from the onset of AMI in group A. We assessed cardiovascular and all cause mortality, incidence of major acute coronary events (MACE), incidence of non-fatal AMI, the evolution of left ventricle ejection fraction (LVEF), wall motion score index (WMSI) and left ventricle end-systolic and end-diastolic diameters. The follow-up period was one year.
There were no statistically significant differences between groups regarding cardiovascular and all cause mortality, incidence of MACE, incidence of non-fatal MI. LVEF significantly increased at 1 year in both groups. In both groups the reduction of end-systolic and end-diastolic diameters at 1 year was statistically significant. Echocardiographic findings demonstrated also a significant decrease of WMSI at 1 year in both groups.
The dual renin-angiotensin system blockade (ARBs and ACE inhibitor) has proved its beneficial effect on the improvement of left ventricular function, without increasing cardiovascular mortality and incidence of non fatal myocardial infarction (MI) in patients with AMI treated by primary PCI and stenting within a 1 year follow-up period.
肾素-血管紧张素系统（RAS）的激活是心室重塑的主要决定因素。我们前瞻性评估了在接受直接经皮冠状动脉介入治疗（PCI）和支架置入术的急性心肌梗死（AMI）患者中，双重RAS阻断（血管紧张素II AT1受体阻滞剂和血管紧张素转换酶抑制剂治疗）是否对改善左心室功能有益。次要目的是证明血管紧张素转换酶（ACE）抑制剂、血管紧张素II AT1受体阻滞剂（ARB）和β受体阻滞剂三联疗法不会增加心血管发病率、心血管死亡率和全因死亡率。
我们调查了44例ST段抬高型AMI患者，他们接受了直接PCI和支架置入术。所有患者均接受包括ACE抑制剂和β受体阻滞剂在内的标准治疗。我们将患者分为A组和B组。A组在AMI发作后的前6小时内将缬沙坦添加到标准治疗中。我们评估了心血管和全因死亡率、主要急性冠状动脉事件（MACE）的发生率、非致命性AMI的发生率、左心室射血分数（LVEF）的变化、壁运动评分指数（WMSI）以及左心室收缩末期和舒张末期直径。随访期为一年。
两组在心血管和全因死亡率、MACE发生率、非致命性心肌梗死发生率方面无统计学显著差异。两组在1年时LVEF均显著增加。两组在1年时收缩末期和舒张末期直径的减小均具有统计学意义。超声心动图结果还显示两组在1年时WMSI均显著降低。
在1年的随访期内，对于接受直接PCI和支架置入术治疗的AMI患者，双重肾素-血管紧张素系统阻断（ARB和ACE抑制剂）已证明其对改善左心室功能有益，且不会增加心血管死亡率和非致命性心肌梗死（MI）的发生率。
