van Gilst W H, Kingma J H
Department of Clinical Pharmacology, University of Groningen, The Netherlands.
Am J Cardiol. 1991 Nov 18;68(14):111D-115D. doi: 10.1016/0002-9149(91)90267-o.
The adjunctive use of angiotensin-converting enzyme (ACE) inhibitors with thrombolytic therapy early during acute myocardial infarction offers theoretic advantages. In the acute phase, captopril may scavenge free radicals, blunt the catecholamine response, elicit coronary vasodilation, and increase prostacyclin and bradykinin levels. In the chronic phase, ventricular remodeling may be attenuated. At present, a large number of controlled clinical trials mainly focusing on the effects of ACE inhibition in the chronic phase are underway. Only a few studies concentrate on the effect of acute intervention with ACE inhibitors in ischemia-reperfusion, i.e., thrombolysis in myocardial infarction. In April 1990 under auspices of the Interuniversity Cardiology Institute of the Netherlands, a large nationwide acute intervention trial with captopril in 280 patients receiving thrombolytic therapy was started, the Captopril and Thrombolysis Study (CATS). The primary hypothesis of CATS supposes a very early effect of ACE inhibition on evolving myocardial damage due to ischemia and the consequences of early reperfusion. This will be evaluated by serial echocardiography, Holter monitoring and neurohumoral measurements immediately on thrombolysis and during the first year after myocardial infarction.
在急性心肌梗死早期，将血管紧张素转换酶（ACE）抑制剂与溶栓治疗联合使用具有理论上的优势。在急性期，卡托普利可清除自由基、减弱儿茶酚胺反应、引起冠状动脉扩张，并提高前列环素和缓激肽水平。在慢性期，心室重构可能会减轻。目前，大量主要关注ACE抑制在慢性期作用的对照临床试验正在进行中。只有少数研究关注ACE抑制剂在缺血再灌注（即心肌梗死溶栓）中的急性干预效果。1990年4月，在荷兰大学间心脏病学研究所的支持下，一项针对280例接受溶栓治疗患者使用卡托普利的大型全国性急性干预试验——卡托普利与溶栓研究（CATS）启动。CATS的主要假设是，ACE抑制对因缺血导致的正在发展的心肌损伤以及早期再灌注的后果具有非常早期的作用。这将通过在溶栓时以及心肌梗死后第一年立即进行的系列超声心动图、动态心电图监测和神经体液测量来评估。
