Efficacy of captopril before thrombolysis in acute myocardial infarction: preliminary findings.

Studies on experimental animals indicate that ACE-inhibition might play an important role in coronary flow regulation and reperfusion damage limitation by alleviating non-irreversible myocardial damage and reducing Hyperkinetic Ventricular Arrhythmias (HVA) caused by reperfusion. This suggests the usefulness of captopril, an ACE-inhibitor containing the -SH group, in combination with systemic thrombolysis or mechanical revascularisation. The study was performed on seventy-two patients admitted to the hospital within 4 h of the onset of major cardiac symptoms due to Unstable Angina Pectoris (UAP) or Acute Myocardial Infarction (AMI). They were randomized either to treatment with oral captopril 15 min before thrombolysis (thirty-seven patients), or to thrombolysis followed by oral captopril on day 3-4 (thirty-five patients). In the early captopril-treated patients, a significant reduction in early arrhythmias was observed within 2 h, a lower incidence of late arrhythmias and a faster normalisation of necrosis enzymes. These data provide further evidence for the useful role of early captopril treatment in acute myocardial infarction.