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European Heart Journal 1996 17(10):1506-1510;
Copyright © 1996 by the European Society of Cardiology.
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© 1996 The European Society of Cardiology

Effects of captopril on ventricular arrhythmias in the early and late phase of suspected acute myocardial infarction

Randomized, placebo-controlled substudy of ISIS-4

A. Budaj, J. Cybulski, K. Cedro, S. Karczmarewicz, J. Maciejewicz*, M. Wisniewski and L. Ceremuzynski

Postgraduate Medical School, Grochowski Hospital Warsaw, Poland
*Dietla Hospital Cracow, Poland

revised 19 January 1996; accepted 15 February 1996.

Andrzej Budaj, MD, Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Grenadierów 51/59, 04/073 Warsaw, Poland.

Abstract

The antiarrhythmic effect of oral captopril was studied during the early (day 3) and late (day 14) phase of acute myocardial infarction among 304 patients in a randomized placebo-controlled substudy of ISIS-4.

Ventricular arrhythmias (ventricular ectopic beats per hour) occurred significantly less frequently among captopril-allocated patients than among those allocated placebo at day 3 (logarithmic scale: 0·48 ± 0·8 captopril vs 0·84 ± 1·3 placebo; P<0·003) and at day 14 (0·51 ± 1·0 vs 0·77 ± 1·3; P<0·05). The number of patients with frequent ventricular arrhythmias (more than 10 ventricular ectopic beats per hour) was also significantly lower among those allocated captopril at day 3 (7·3% vs 14·4% P<0·05) and at day 14 (7·3% vs 14·8%; P<0·05).

These results support the hypothesis that the activation of the renin-angiotensin-aldosterone and sympathetic system may underlie heart rhythm disturbances in acute myocardial infarction, and that early use of converting enzyme inhibitor therapy may ameliorate these disturbances.

(Eur Heart J 1996; 17: 1506–1510)

Key Words: Myocardial infarction • ventricular arrhythmias • ACE inhibitors • captopril • antiarrhythmic effect


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