[Captopril administration before thrombolysis in patients with an acute myocardial infarct: a pilot study of the short- and long-term effects].

Several experimental studies, carried out on animals and on isolated heart, showed that captopril can reduce the post-ischemic reperfusion injury. Our study was aimed at checking the effects of captopril before thrombolysis in acute myocardial infarction (AMI) and included 204 patients, hospitalized within 4 hours from the onset of symptoms. Patients were randomly subdivided into 2 groups: the first group (105 patients, Group A: pretreatment) received 6.25 mg captopril orally about 15 min before iv administration of urokinase (2 million), the second group (99 patients, Group B: late-treatment) received captopril about 3 days after thrombolytic treatment. Captopril doses were later increased in both groups according to blood pressure. All patients were subdivided according to the localization of infarction. One hundred and thirty-seven patients showed anterior AMI (70 from Group A and 67 from Group B); 67 patients showed inferior AMI (35 from Group A and 32 from Group B). Ventricular hyperkinetic arrhythmias (VHA) due to reperfusion were evaluated during the first 2 hours. Ventricular hyperkinetic arrhythmias occurred in 11.4% of patients with anterior AMI in Group A versus 38.8% in Group B (p < 0.001). CK peak normalization time in the group with anterior AMI was achieved after 58 +/- 2 hours in Group A versus 72 +/- 2 hours in Group B (p < 0.01). Late arrhythmias, > Lown's class 2 was found to occur in 15.7% of patients with anterior AMI of Group A versus 32.8% in Group B (p < 0.05), at predischarge Holter test. One hundred and nineteen patients underwent a hemodynamic test about 3 weeks after AMI.(ABSTRACT TRUNCATED AT 250 WORDS)