Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1993 Feb;69(2):161–165. doi: 10.1136/hrt.69.2.161

Effects on ventricular arrhythmias of oral captopril and of oral mononitrate started early in acute myocardial infarction: results of a randomised placebo controlled trial.

A Pipilis 1, M Flather 1, R Collins 1, A Hargreaves 1, T Kolettis 1, N Boon 1, C Foster 1, P Appleby 1, P Sleight 1
PMCID: PMC1024944  PMID: 7679583

Abstract

OBJECTIVE--To assess the effects of oral vasodilator treatment on ventricular arrhythmias in acute myocardial infarction. SETTING--Coronary care units at the John Radcliffe Hospital, Oxford, and the Royal Infirmary, Edinburgh. PATIENTS--100 patients with suspected acute myocardial infarction entered the study at a mean of 13 hours from symptom onset. DESIGN OF INTERVENTION--Double blind randomisation to 4 weeks treatment with captopril (12.5 mg three times a day after a 6.25 mg test dose (n = 32)) or isosorbide mononitrate (20 mg three times a day (n = 31)) or placebo control (n = 37). OUTCOME MEASURES--Ventricular arrhythmic events assessed by 48 hours of Holter monitoring starting at the time of randomisation. RESULTS--The number of ventricular extrasystoles/hour for captopril, mononitrate, and placebo was respectively (median and range) 6 (0-162), 4 (0-38), and 10 (0-932) (2p < 0.02 mononitrate v placebo). The number of episodes of multiple extrasystoles/hour was 0.2 (0-22), 0.3 (0-4), and 0.5 (0-19); (2p < 0.02 mononitrate v placebo). Episodes of ventricular tachycardia showed a non-significant decrease in the captopril and mononitrate groups (mean (SEM) 3.2 (0.8), 2.4 (0.7), and 4.7 (1.3) for the 48 hour period). The incidence of idioventricular rhythm was also reduced in both active treatment groups (28%, 19%, and 46% (2p < 0.05 mononitrate v placebo)). CONCLUSIONS--Oral mononitrate (and perhaps also captopril) seems to reduce the incidence of ventricular arrhythmias in the early phase of acute myocardial infarction. The effects on life-threatening arrhythmias, such as ventricular fibrillation, and on death can only be assessed in a much larger trial.

Full text

PDF
161

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bussmann W. D., Neumann K., Kaltenbach M. Effects of intravenous nitroglycerin on ventricular ectopic beats in acute myocardial infarction. Am Heart J. 1984 May;107(5 Pt 1):940–944. doi: 10.1016/0002-8703(84)90832-9. [DOI] [PubMed] [Google Scholar]
  2. Campbell R. W., Murray A., Julian D. G. Ventricular arrhythmias in first 12 hours of acute myocardial infarction. Natural history study. Br Heart J. 1981 Oct;46(4):351–357. doi: 10.1136/hrt.46.4.351. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Ceremuzyński L., Staszewska-Barczak J., Herbaczynska-Cedro K. Cardiac rhythm disturbances and the release of catecholamines after acute coronary occlusion in dogs. Cardiovasc Res. 1969 Apr;3(2):190–197. doi: 10.1093/cvr/3.2.190. [DOI] [PubMed] [Google Scholar]
  4. Cleland J. G., Dargie H. J., Hodsman G. P., Ball S. G., Robertson J. I., Morton J. J., East B. W., Robertson I., Murray G. D., Gillen G. Captopril in heart failure. A double blind controlled trial. Br Heart J. 1984 Nov;52(5):530–535. doi: 10.1136/hrt.52.5.530. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Corbalan R., Verrier R. L., Lown B. Differing mechanisms for ventricular vulnerability during coronary artery occlusion and release. Am Heart J. 1976 Aug;92(2):223–230. doi: 10.1016/s0002-8703(76)80258-x. [DOI] [PubMed] [Google Scholar]
  6. Derrida J. P., Sal R., Chiche P. Favorable effects of prolonged nitroglycerin infusion in patients with acute myocardial infarction. Am Heart J. 1978 Dec;96(6):833–834. doi: 10.1016/0002-8703(78)90020-0. [DOI] [PubMed] [Google Scholar]
  7. Greene H. L., Roden D. M., Katz R. J., Woosley R. L., Salerno D. M., Henthorn R. W. The Cardiac Arrhythmia Suppression Trial: first CAST ... then CAST-II. J Am Coll Cardiol. 1992 Apr;19(5):894–898. doi: 10.1016/0735-1097(92)90267-q. [DOI] [PubMed] [Google Scholar]
  8. Hemsworth P. D., Pallandi R. T., Campbell T. J. Cardiac electrophysiological actions of captopril: lack of direct antiarrhythmic effects. Br J Pharmacol. 1989 Sep;98(1):192–196. doi: 10.1111/j.1476-5381.1989.tb16881.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Henning H., Hardarson T., Francis G., O'Rourke R. A., Ryan W., Ross J., Jr Approach to the estimation of myocardial infarct size by analysis of precordial S-T segment and R wave maps. Am J Cardiol. 1978 Jan;41(1):1–8. doi: 10.1016/0002-9149(78)90124-8. [DOI] [PubMed] [Google Scholar]
  10. James M. A., Jones J. V. Systolic wall stress and ventricular arrhythmia: the role of acute change in blood pressure in the isolated working rat heart. Clin Sci (Lond) 1990 Nov;79(5):499–504. doi: 10.1042/cs0790499. [DOI] [PubMed] [Google Scholar]
  11. Jewitt D. E., Reid D., Thomas M., Mercer C. J., Valori C., Shillingford J. P. Free noradrenaline and adrenaline excretion in relation to the development of cardiac arrhythmias and heart-failure in patients with acute myocardial infarction. Lancet. 1969 Mar 29;1(7596):635–641. doi: 10.1016/s0140-6736(69)92009-1. [DOI] [PubMed] [Google Scholar]
  12. Jugdutt B. I., Warnica J. W. Intravenous nitroglycerin therapy to limit myocardial infarct size, expansion, and complications. Effect of timing, dosage, and infarct location. Circulation. 1988 Oct;78(4):906–919. doi: 10.1161/01.cir.78.4.906. [DOI] [PubMed] [Google Scholar]
  13. Lie K. I., Wellens H. J., Downar E., Durrer D. Observations on patients with primary ventricular fibrillation complicating acute myocardial infarction. Circulation. 1975 Nov;52(5):755–759. doi: 10.1161/01.cir.52.5.755. [DOI] [PubMed] [Google Scholar]
  14. Lown B., Klein M. D., Hershberg P. I. Coronary and precoronary care. Am J Med. 1969 May;46(5):705–724. doi: 10.1016/0002-9343(69)90022-9. [DOI] [PubMed] [Google Scholar]
  15. Lown B., Wolf M. Approaches to sudden death from coronary heart disease. Circulation. 1971 Jul;44(1):130–142. doi: 10.1161/01.cir.44.1.130. [DOI] [PubMed] [Google Scholar]
  16. MacMahon S., Collins R., Peto R., Koster R. W., Yusuf S. Effects of prophylactic lidocaine in suspected acute myocardial infarction. An overview of results from the randomized, controlled trials. JAMA. 1988 Oct 7;260(13):1910–1916. [PubMed] [Google Scholar]
  17. Magrini F., Reggiani P., Roberts N., Meazza R., Ciulla M., Zanchetti A. Effects of angiotensin and angiotensin blockade on coronary circulation and coronary reserve. Am J Med. 1988 Mar 11;84(3A):55–60. doi: 10.1016/0002-9343(88)90205-7. [DOI] [PubMed] [Google Scholar]
  18. McAlpine H. M., Morton J. J., Leckie B., Rumley A., Gillen G., Dargie H. J. Neuroendocrine activation after acute myocardial infarction. Br Heart J. 1988 Aug;60(2):117–124. doi: 10.1136/hrt.60.2.117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. McKay R. G., Pfeffer M. A., Pasternak R. C., Markis J. E., Come P. C., Nakao S., Alderman J. D., Ferguson J. J., Safian R. D., Grossman W. Left ventricular remodeling after myocardial infarction: a corollary to infarct expansion. Circulation. 1986 Oct;74(4):693–702. doi: 10.1161/01.cir.74.4.693. [DOI] [PubMed] [Google Scholar]
  20. Michorowski B., Ceremuzyński L. The renin-angiotensin--aldosterone system and the clinical course of acute myocardial infarction. Eur Heart J. 1983 Apr;4(4):259–264. doi: 10.1093/oxfordjournals.eurheartj.a061457. [DOI] [PubMed] [Google Scholar]
  21. O'Doherty M., Tayler D. I., Quinn E., Vincent R., Chamberlain D. A. Five hundred patients with myocardial infarction monitored within one hour of symptoms. Br Med J (Clin Res Ed) 1983 Apr 30;286(6375):1405–1408. doi: 10.1136/bmj.286.6375.1405. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Olsson G., Rehnqvist N. Evaluation of antiarrhythmic effect of metoprolol treatment after acute myocardial infarction: relationship between treatment responses and survival during a 3-year follow-up. Eur Heart J. 1986 Apr;7(4):312–319. doi: 10.1093/oxfordjournals.eurheartj.a062069. [DOI] [PubMed] [Google Scholar]
  23. Pfeffer M. A., Lamas G. A., Vaughan D. E., Parisi A. F., Braunwald E. Effect of captopril on progressive ventricular dilatation after anterior myocardial infarction. N Engl J Med. 1988 Jul 14;319(2):80–86. doi: 10.1056/NEJM198807143190204. [DOI] [PubMed] [Google Scholar]
  24. Sharpe N., Murphy J., Smith H., Hannan S. Treatment of patients with symptomless left ventricular dysfunction after myocardial infarction. Lancet. 1988 Feb 6;1(8580):255–259. doi: 10.1016/s0140-6736(88)90347-9. [DOI] [PubMed] [Google Scholar]
  25. Sharpe N., Smith H., Murphy J., Greaves S., Hart H., Gamble G. Early prevention of left ventricular dysfunction after myocardial infarction with angiotensin-converting-enzyme inhibition. Lancet. 1991 Apr 13;337(8746):872–876. doi: 10.1016/0140-6736(91)90202-z. [DOI] [PubMed] [Google Scholar]
  26. Sideris D. A., Kontoyannis D. A., Michalis L., Adractas A., Moulopoulos S. D. Acute changes in blood pressure as a cause of cardiac arrhythmias. Eur Heart J. 1987 Jan;8(1):45–52. doi: 10.1093/oxfordjournals.eurheartj.a062158. [DOI] [PubMed] [Google Scholar]
  27. Webster M. W., Fitzpatrick M. A., Nicholls M. G., Ikram H., Wells J. E. Effect of enalapril on ventricular arrhythmias in congestive heart failure. Am J Cardiol. 1985 Sep 15;56(8):566–569. doi: 10.1016/0002-9149(85)91186-5. [DOI] [PubMed] [Google Scholar]
  28. deGraeff P. A., deLangen C. D., van Gilst W. H., Bel K., Scholtens E., Kingma J. H., Wesseling H. Protective effects of captopril against ischemia/reperfusion-induced ventricular arrhythmias in vitro and in vivo. Am J Med. 1988 Mar 11;84(3A):67–74. doi: 10.1016/0002-9343(88)90207-0. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES