European Heart Journal Advance Access originally published online on August 21, 2009
European Heart Journal 2009 30(22):2733-2741; doi:10.1093/eurheartj/ehp301
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Effect of irbesartan and enalapril in non-ST elevation acute coronary syndrome: results of the randomized, double-blind ARCHIPELAGO study
1 Bureau 2-236, Institut de Cardiologie, Hôpital Pitié-Salpétrière, 47 boulevard de l'hôpital, 75013 Paris, France
2 Hochschule Hannover, Hannover, Germany
3 Institut de Cardiologie, Montreal, Quebec, Canada
4 University of Rochester Medical Center, New York, NY, USA
5 sanofi aventis, Paris, France
6 Cleveland Clinic, Cleveland, OH, USA
Received 27 August 2008; revised 23 April 2009; accepted 3 July 2009; online publish-ahead-of-print 21 August 2009.
* Corresponding author. Tel: +33 1 42 16 30 07, Fax: +33 1 42 16 29 31, Email: gilles.montalescot{at}psl.ap-hop-paris.fr
Aims: This study investigated the effects of irbesartan vs. enalapril, with early vs. late treatment, on markers of inflammation and ischaemic heart disease in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS).
Methods and results: Patients hospitalized with ischaemic symptoms and evidence of NSTEACS were randomized to early (at hospitalization) or late (at hospital discharge) treatment with irbesartan 150 mg/day followed by 300 mg/day on day 15 (n = 212) or enalapril 10 mg/day followed by 20 mg/day on day 15 (n = 217) to day 60. The primary endpoint was the change from baseline in high-sensitivity C-reactive protein (hs-C-reactive protein) at day 60; secondary endpoints included changes in troponin I, B-type natriuretic peptide, microalbuminuria, interleukin 6, myeloperoxidase, secretory non-pancreatic type II phospholipase A2, ischaemia-modified albumin, soluble CD40 ligand, matrix metalloproteinase-9, aldosterone, and blood pressure. High-sensitivity C-reactive protein levels were comparable in both the irbesartan and enalapril treatment arms. There were no treatment-related differences in any of the biomarkers measured. Changes in inflammatory markers were unaffected by the timing of treatment initiation. Both treatments were well tolerated, with no differences in major adverse cardiac events.
Conclusion: In patients with NSTEACS, inflammatory markers decreased over time in both treatment arms, with no differences between irbesartan and enalapril.
Key Words: Non-STE acute coronary syndrome • Inflammatory markers • Irbesartan • Enalapril
ARCHIPELAGO: Acute coronary syndromes Randomized to a Controlled evaluation in the first Hours of presentation with Irbesartan vs. enalapril to Prevent Elevated inflammation, Limit myocardial ischemia And Generate better Outcome.