Ambrosioni E, Borghi C, Magnani B
Institute of Internal Medicine, University of Bologna, Italy.
Am J Cardiol. 1991 Nov 18;68(14):101D-110D. doi: 10.1016/0002-9149(91)90266-n.
The use of angiotensin-converting enzyme (ACE) inhibitors in acute myocardial infarction (AMI) is based on their capacity to limit ventricular enlargement and dysfunction. To date, the safety profile of administration of ACE inhibitors early in the course of AMI has not been established. In-hospital and long-term consequences of treatment with the ACE inhibitor zofenopril initiated within 24 hours of the onset of symptoms were compared with those of standard treatment in an open-label trial involving 204 patients with AMI who were not undergoing thrombolytic treatment. Zofenopril promptly blocked ACE activation. Blockade was almost complete (91 +/- 6%) after 72 hours and paralleled decreases in systolic blood pressure. Systemic blood pressure was acutely reduced by zofenopril, and severe but reversible hypotension occurred in 15% of hospitalized patients and in 3% of those treated over the long term. No adverse clinical or biochemical events were reported during the course of zofenopril therapy. Overall cardiovascular mortality was not significantly reduced by early zofenopril compared with placebo therapy (7.8% vs 10.7% [difference not significant]). The inhospital incidence of acute left ventricular failure and ventricular arrhythmias decreased by 63% and 39%, respectively, among zofenopril-treated patients, who also reported fewer anginal episodes both acutely (68% reduction) and over the long term (56% reduction) and did not require as much drug treatment (i.e., diuretics, digoxin, and/or anti-ischemic agents) during the follow-up phase. Left ventricular size decreased and ejection fraction (EF) increased in patients who received zofenopril, and the improvement was greater among patients with poorer ventricular function (EF less than 40%). Early administration of ACE inhibitors may therefore constitute a safe form of therapy for patients with AMI, particularly when the event is complicated by clinical signs or evidence of ventricular dysfunction.
血管紧张素转换酶（ACE）抑制剂用于急性心肌梗死（AMI）是基于其限制心室扩大和功能障碍的能力。迄今为止，AMI病程早期给予ACE抑制剂的安全性尚未确立。在一项开放标签试验中，将症状发作后24小时内开始使用ACE抑制剂佐芬普利治疗与标准治疗的住院及长期后果进行了比较，该试验纳入了204例未接受溶栓治疗的AMI患者。佐芬普利迅速阻断ACE激活。72小时后阻断几乎完全（91±6%），并与收缩压下降平行。佐芬普利使全身血压急性降低，15%的住院患者和3%的长期治疗患者发生严重但可逆的低血压。佐芬普利治疗过程中未报告不良临床或生化事件。与安慰剂治疗相比，早期使用佐芬普利并未显著降低总体心血管死亡率（7.8%对10.7%[差异不显著]）。在接受佐芬普利治疗的患者中，急性左心室衰竭和室性心律失常的住院发生率分别降低了63%和39%，这些患者急性发作时（减少68%）和长期发作时（减少56%）的心绞痛发作也较少，且随访期内所需药物治疗（即利尿剂、地高辛和/或抗缺血药物）也较少。接受佐芬普利治疗的患者左心室大小减小，射血分数（EF）增加，心室功能较差（EF小于40%）的患者改善更大。因此，早期给予ACE抑制剂可能是AMI患者的一种安全治疗方式，尤其是当该事件伴有心室功能障碍的临床体征或证据时。
