Beneficial effects of angiotensin-converting enzyme inhibitor and nitrate association on left ventricular remodeling in patients with large acute myocardial infarction: the delapril remodeling after acute myocardial infarction (DRAMI) trial
| Autor: | Paolo Marino, Giovanni Cremonesi, Violeta Labarta, Federico Bianchi, Enrico Geraci, Lidia Staszewsky, Gianni Tognoni, Silvana Gramenzi, Giuseppe Sarcina, Roberto Latini, Gian Luigi Nicolosi, Francisco Hernandez-Bernal, Aldo P. Maggioni |
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| Rok vydání: | 2003 |
| Předmět: |
Male
medicine.medical_specialty Vasodilator Agents Statistics as Topic Myocardial Infarction Delapril Angiotensin-Converting Enzyme Inhibitors Isosorbide Dinitrate Placebo Lisinopril Internal medicine medicine Humans Myocardial infarction Ventricular remodeling Aged Ventricular Remodeling business.industry Middle Aged Placebo Effect medicine.disease Tolerability Heart failure Indans Cardiology Female Isosorbide dinitrate Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Scopus-Elsevier |
| ISSN: | 0002-8703 |
| Popis: | Background In the large-scale trial, Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-3 (GISSI-3), patients receiving the combination of lisinopril and glyceryl trinitrate benefited most from experimental therapy. Therefore, a multicenter, randomized, double-blind study, Delapril Remodeling After Acute Myocardial Infarction (DRAMI), was designed to assess (1) the possible additive beneficial effect on left ventricular remodeling of nitrates when combined with an angiotensin-converting enzyme inhibitor (ACEI), and (2) the tolerability of a new ACEI, delapril, in respect to lisinopril in patients with large myocardial infarction (MI). Methods A total of 177 patients were randomized to receive delapril plus isosorbide-5-mononitrate (IS5MN) placebo, delapril plus IS5MN, lisinopril plus IS5MN placebo, or lisinopril plus IS5MN starting within the first 36 hours after the onset of symptoms and continuing for 3 months. Results More than 80% of the patients showed extensive ST-segment changes and 36.7% had signs or symptoms of heart failure during the first 36 hours. Over 3 months, IS5MN reduced, by 76%, the increase in LVEDV (17.4 ± 5.0 mL placebo vs 4.2 ± 4.4 mL IS5MN, P = .0439), reversed the increase in LVESV (7.5 ± 3.9 mL placebo vs −5.5 ± 2.9 mL IS5MN, P = .0052), and increased the recovery of LVEF (1.9% ± 1.3% placebo vs 6.7% ± 1.2% IS5MN, P = .0119). Overall, 3-month mortality was 10.2%; the most frequent clinical events were new episodes of severe heart failure (18.1%), persistent hypotension (10.7%), and post-MI angina (18.1%), with no differences between treatment groups. Conclusions Administration for 3 months of IS5MN combined with an ACEI, both started within 36 hours from the onset of symptoms, was safe and effective in reducing LV dilation and dysfunction after MI. The 2 ACEIs, delapril and lisinopril, appeared to be equally well tolerated. |
| Databáze: | OpenAIRE |
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