Raggi P, Dickson N R, Boyne M, Pereira R, Cooil B, Wattanasuwan N, Russell D C
University of Virginia, Charlottesville, USA.
Ann Pharmacother. 1998 Nov;32(11):1141-6. doi: 10.1345/aph.18071.
Angiotensin-converting enzyme inhibitor (ACE-I) therapy reduces complications of acute myocardial infarction (MI) even when the therapy is started very early after an acute event. This study sought to determine whether administration of ACE-I therapy prior to acute MI is related to subsequent patient morbidity and mortality.
Chart review of 318 consecutive patients admitted between September 1995 and December 1996 with a diagnosis of acute MI. Outcome data were compared between patient groups receiving ACE-I therapy prior to infarction and those who were not.
Sixty-four patients (20%) were receiving prior ACE-I therapy. They experienced smaller MIs, as determined by peak creatine kinase elevation (1066 +/- 134 vs. 1510 +/- 95 IU; p < 0.05), and fewer Q-wave infarctions (p < 0.05) than did patients who were not receiving prior treatment. The severity of coronary artery disease, defined by an angiographic score, was similar for the two groups. Mortality rates, including patients resuscitated from ventricular fibrillation, were similar within the first 72 hours of admission (3% vs. 2%; p = NS), but patients receiving prior ACE-I therapy showed a greater long-term in-hospital mortality rate (14% vs. 5%; p < 0.05) related to more heart failure deaths. Multivariate logistic regression analysis identified age, treatment with digoxin prior to acute MI, and left ventricular ejection fraction after infarction, but not ACE-I therapy taken prior to infarction, as significant independent predictors of mortality and combined morbidity and mortality.
In a group of patients experiencing an acute MI, those receiving prior ACE-I therapy were more likely to sustain fewer transmural MIs and smaller infarcts. Chronic ACE-I therapy may have cardioprotective effects during acute myocardial ischemia.
血管紧张素转换酶抑制剂（ACE-I）治疗可降低急性心肌梗死（MI）的并发症，即使在急性事件发生后很早就开始治疗。本研究旨在确定急性心肌梗死之前给予ACE-I治疗是否与随后患者的发病率和死亡率相关。
对1995年9月至1996年12月期间连续收治的318例诊断为急性心肌梗死的患者进行病历回顾。比较梗死前接受ACE-I治疗的患者组和未接受治疗的患者组的结局数据。
64例患者（20%）之前接受过ACE-I治疗。与未接受过治疗的患者相比，根据肌酸激酶峰值升高情况判断，他们发生的心肌梗死面积较小（1066±134 vs. 1510±95 IU；p<0.05），Q波梗死较少（p<0.05）。两组患者由血管造影评分定义的冠状动脉疾病严重程度相似。入院后72小时内的死亡率，包括从心室颤动中复苏的患者，两组相似（3% vs. 2%；p=无显著性差异），但之前接受ACE-I治疗的患者长期住院死亡率更高（14% vs. 5%；p<0.05），这与更多的心衰死亡有关。多因素逻辑回归分析确定年龄、急性心肌梗死前使用地高辛治疗以及梗死后左心室射血分数，但不包括梗死前使用的ACE-I治疗，是死亡率以及合并发病率和死亡率的显著独立预测因素。
在一组发生急性心肌梗死的患者中，之前接受ACE-I治疗的患者更有可能发生较少的透壁性心肌梗死且梗死面积较小。慢性ACE-I治疗在急性心肌缺血期间可能具有心脏保护作用。
