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PubMed1996

Beneficial effects of captopril on prognosis in patients with acute myocardial infarction. Shanghai Secondary Prevention of Acute Myocardial Infarction Study Group.

OBJECTIVES: To assess the effects of early and long-term angiotensin-converting enzyme inhibitor treatment with captopril on clinical outcome in patients with acute myocardial infarction (AMI). METHODS: Eight hundred and twenty-two patients with AMI who were hospitalised within 72 hours of symptoms and had no cardiogenic shock were randomly allocated to captopril (n = 478, Group I) and conventional treatment (n = 344, Group II). Cardiac events including congestive heart failure, reinfarction, severe arrhythmias and cardiac death during hospitalization and follow-up period (average 20 months) were determined. RESULTS: The overall mortality rate during hospitalization was lower in group I than in group II (P = 0.0001), this was true for patients with anterior (P = 0.0003), inferior (P = 0.0411) and anterior inferior AMI (P = 0.0232). During follow-up, despite similar occurrence rate of reinfarction and severe arrhythmias in the two groups, the mortality rate (P = 0.0324) and total cardiac event rate (P = 0.055) were lower in group I than in group II. CONCLUSIONS: After AMI, early and long-term treatment with captopril exerts a beneficial effect on the prognosis of patients.

Aged↗
PubMed1997

Functional disability before myocardial infarction in the elderly as a determinant of infarction severity and postinfarction mortality.

BACKGROUND: Functional disability is a common condition among elderly patients. However, to our knowledge, its effect on outcome of myocardial infarction (MI) has not been assessed. Our objectives were to determine whether disability in the activities of daily living measured before MI is a predictor of MI severity and mortality. METHODS: Disability in activities of daily living was measured prospectively in a cohort of 222 patients who were hospitalized with acute MI. Outcome measures were severity characteristics on admission to the hospital (higher Killip class, presence of new Q waves in the first electrocardiogram, and lower systolic blood pressure), and 6-month mortality. RESULTS: Patients with disability before hospitalization were older and had more comorbidity. After adjusting for these factors and for delay in hospital arrival, disability was still significantly associated with clinical severity on admission to the hospital and with mortality (adjusted relative risk of death for patients with disability vs patients without disability, 2.01; 95% confidence interval, 1.23-3.28). Clinical severity and hospital treatment explained the higher mortality of patients with disability. When these factors were added to the previous model, the relative risk of mortality for patients with disability vs patients without disability was 1.24, and the 95% confidence interval was 0.73 to 2.12. CONCLUSIONS: Functional disability in activities of daily living before MI is an important predictor of clinical severity and mortality in elderly patients with MI. This effect is only minimally explained by the older age and higher comorbidity of patients with disability. However, higher clinical severity and lower use of treatment interventions are major determinants of their higher mortality compared with patients without disability.

Activities of Daily Living↗
PubMed2002

Calcium blocker therapy before myocardial infarction increases post-infarction short- and long-term mortality. Data from the INJECT trial.

BACKGROUND: Short-acting calcium channel blockers (Ca-blockers) have been shown in some studies to increase the risk of myocardial infarction (MI) and post-MI complications. Data from large, international, randomised studies such as the INJECT trial may bring new important information on the effects of medication used before MI, on the course of MI and post-MI complications. AIM: To assess the effects of beta-blocker and Ca-blocker therapy administered prior to MI on the early and late outcome after MI. METHODS: The study group consisted of 6001 patients with acute MI treated according to the INJECT protocol. The patients were divided into four groups according to the type of treatment before the index MI: Group I (n=580) - patients treated with beta-blockers; Group II (n=831) - patients treated with Ca-blockers; Group III (n=277) - patients treated with both beta-blockers and Ca-blockers; and Group IV (n=4313) - no beta-blocker or Ca-blocker treatment. The analysed end-points were 35- and 180-day mortality as well as angina recurrences, occurrence of heart failure, atrial fibrillation/flutter and asystole. RESULTS: During hospital stay, supraventricular arrhythmias, asystole, recurrent ischaemia and heart failure occurred more frequently in patients from groups II and III than in other groups. Early mortality was significantly higher in group II (p<0.001) and group III (p<0.002) than in group IV. Late mortality was the lowest in group IV, followed by group I. Cox proportional hazards multivariable analysis revealed that hypotension, Killip class IV (p<0.001), previous Ca-blocker (p<0.01) or Ca- and beta-blocker treatment (p<0.01) as well as previous MI (p<0.05) were the independent predictors of death. CONCLUSIONS: Compared with beta-blocker therapy or no treatment, previous use of Ca-blockers increases both early and long-term complication rates in patients with MI.

Journal Article↗