Early administration of captopril and nitroglycerin in combination after acute myocardial infarction: an invasive haemodynamic study

The combination of captopril and nitroglycerin early after acutemyocardial infarction (AMI) could lead to a dangerous decreasein blood pressure coronary perfusion. To evaluate the safetyaspects and haemodynamic effects of this combination, we studied36 first ‘Q wave’ thrombolysed anterior wall AMIpatients during the 24 h following the onset of symptoms. Afterwards, thrombolysis patients received a continuous infusionof nitroglycerin and were submitted to pulmonary artery catheterization.Those patients with mean arterial pressure (MAP) 70 mmHg, cardiacindex 2.21. min^–1.m^–2, and wedge pressure 10 mmHgwere included and randomized to receive 6.25 mg of captoprilevery 6 h on the first day and 12.5 mg qid on the second f MAP 70mmHg (group 1). A second group (group 2) received a placebo.Haemodynamic parameters were determined after 1, 6 and thenevery 6 h up to 48 h after basal measurements. Significant differenceswere observed only for the MAP and the rate-pressure product(reduction in group 1 values, P <0.05). However, MAP wasmaintained within acceptable limits. Our data support the factthat the combination of captopril and nitroglycerin in the earlyhours of a non-complicated anterior wall AMI is safe, and couldguarantee its use in large clinical trials to determine theeffects on left ventricle remodelling and survival after AMI.     

Ridogrel does not increase the speed and rate of coronary recanalization in patients with myocardial infarction treated with alteplase and heparin

Ridogrel, a compound with the dual property of inhibiting thesynthesis of thromboxane and blocking the receptors of thromboxanelprostaglandinlendoperoxides,has been shown to accelerate the speed of recanalization andto delay or prevent reocclusion during systemic thrombolysiswith tissue plasminogen activator in experimental animals. Ninetypatients who had not taken any antiplatelet drugs within thelast 10 days were randomized to either intravenous ASA 250 mgimmediately before the thrombolytic treatment and 100 mg oncea day orally thereafter or ridogrel 300 mg i. v. before thrombolytictreatment and 300 mg b.i.d. orally thereafter. All patientswere given intravenous heparin concomitantly with alteplase.The patency of the infarct-related artery was determined bycoronary angiography before the administration of the thrombolyticagent and by repeated coronary angiography every 15 min untilthe end of the administration of alteplase. A final angiogramwas obtained 48 to 72 h later. At 90 min, the recanalizationand patency rates were the same in the two treatment groupswith no intergroup difference in the speed of recanalization.