Study of antiarrhythmic effect of angiotensin converting enzyme inhibitors in patients with acute myocardial infarction

Abstract EN

The aim of this study was to evaluate the protective effect of Angiotensin Converting Enzyme (ACE) inhibitors against reperfusion induced arrhythmias in Acute myocardial infarction (AMI).

- Eighty sex-and age-matched patients with AMI were studied in the CCU within 6 hours of onset of chest pain and categorized into untreated control (group I) and Captopril and ramipril treated groups (21, 111).

Each group included equal numbers of patients with anterior and inferior infarction.

The diagnosis of AMI was based on WHO (1981) criteria.

All patients were subjected to full clinical examination, (ECG) Chest X-ray, and blood glucose, urea, and creatinine.

Echocardiography examination and 24-hours ambulatory ECG (Holter monitoring) were performed within the first day of admission.

The control group included 20patients (15 males and5 females).

ECG study revealed that the mean total Premature Atrial Contraction (PAC) over 24-hours after admission was lower in captopril-treatment group (34%, P<0.06), than the control group, and was significantly lower in ramipril treatment\group (12%; P<0.01) compared to captopril treated or control groups (P<0.02, and P<0.01, respectively).

Over the period of 24 hours, the mean total number of Premature Ventricular Contraction (PVCs) was significantly lower by 72.6% (P<0.001) in captopril-treatment group and by 67.6% (P<0.001) in ramipril-treated group than that of control group.

The rate of occurrence of episodes of Ventricular Tachycardia (VT) was less in captopril- and-ramipril-Jteeatment patients than in patients of control group.

However, the difference between groups was not significant.

The rate of occurrence of Complex Ventricular beat (CVA) was significantly lower in those receiving captopril and ramipril treatment than in those of untreated control group (P<0.03).

Throughout the 24 hours observation period there was a gradual significant decrease in the prevalence of PVC in all 3 patients groups.

The mean total number of PVC during the observation period in either captopril _ ramipril-treatment groups was significantly less than the mean total number of PVC of the corresponding observation period of control group put not between the two treatment groups.

Comparison between patients with anterior and inferior infarction subgroups shows no significant difference in PVC/hours in each of the 3 AMI groups(Ul III).

The mean left vent.

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(LVED) and diastolic (LVES) dimensions of untreated control AMI patients were significantly longer on day 7 than on day 1 than those of treated group.

Moreover, the mean EDD of control group was still larger than those of captopril- treatment group (P<0.08) and ramipril- treatment groups (P<0.05).

This difference between day 1 and 7 was not observed in captopril- and ramipril- treatment groups who showed normal dimeasions left ventricular systolic and dialtolic functions showed no significant difference among the patients group.

In conclusion the ACE inhibitors seem to have protective effect against reperfusion ventricular arrhythmia after AMI.

This protective effect was not confined to SH-group containing ACE inhibitors, as this is a group effect.

So we recommend the early use of ACE inhibitors in early phase after myocardial infraction.