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Published on: May 26, 2022
Dual renin angiotensin system blockade in patients with acute myocardial infarction and preserved left ventricular
Monica Suşan1, L Petrescu, A I Riviş
1Internal Medicine I Department, City Hospital, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania. monicapurice@yahoo.com
Unlabelled:
The activation of the renin-angiotensin system (RAS) is a major determinant of ventricular remodeling. We prospectively assessed whether the dual RAS blockade (angiotensin II AT 1-receptor blocker and angiotensin-converting enzyme inhibitor therapy) in patients with acute myocardial infarction (AMI) who were treated by primary percutaneous coronary intervention (PCI) and stenting provides benefit on the improvement of the left ventricle function. A secondary aim is to demonstrate that triple therapy with angiotensin-converting enzyme (ACE) inhibitors, angiotensin II AT 1-receptor blockers (ARBs) and beta blockers does not increase cardiovascular morbidity, cardiovascular mortality and all cause mortality.
Methods:
We investigated 44 patients with AMI with ST elevation undergoing primary PCI and stenting. All patients received standard therapy including an ACE inhibitor and a beta blocker. We divided the patients into two groups, A and B. Valsartan was added to the standard therapy within the first 6 hours from the onset of AMI in group A. We assessed cardiovascular and all cause mortality, incidence of major acute coronary events (MACE), incidence of non-fatal AMI, the evolution of left ventricle ejection fraction (LVEF), wall motion score index (WMSI) and left ventricle end-systolic and end-diastolic diameters. The follow-up period was one year.
Results:
There were no statistically significant differences between groups regarding cardiovascular and all cause mortality, incidence of MACE, incidence of non-fatal MI. LVEF significantly increased at 1 year in both groups. In both groups the reduction of end-systolic and end-diastolic diameters at 1 year was statistically significant. Echocardiographic findings demonstrated also a significant decrease of WMSI at 1 year in both groups.
Conclusions:
The dual renin-angiotensin system blockade (ARBs and ACE inhibitor) has proved its beneficial effect on the improvement of left ventricular function, without increasing cardiovascular mortality and incidence of non fatal myocardial infarction (MI) in patients with AMI treated by primary PCI and stenting within a 1 year follow-up period.
Insights
Dual renin-angiotensin system blockade improves left ventricle function after acute myocardial infarction (AMI) without increasing mortality. This therapy is beneficial for patients undergoing primary percutaneous coronary intervention (PCI) and stenting.
Area of Science:
- Cardiology
- Pharmacology
Background:
- The renin-angiotensin system (RAS) significantly influences ventricular remodeling.
- Understanding the impact of dual RAS blockade on left ventricle function post-acute myocardial infarction (AMI) is crucial.
Purpose of the Study:
- To assess the efficacy of dual RAS blockade (angiotensin II AT1-receptor blocker and ACE inhibitor) in improving left ventricle function in AMI patients treated with primary PCI and stenting.
- To evaluate the safety of triple therapy (ACE inhibitors, ARBs, beta-blockers) regarding cardiovascular and all-cause mortality.
Main Methods:
- A prospective study involving 44 patients with ST-elevation AMI undergoing primary PCI.
- Patients received standard therapy; Group A additionally received Valsartan within 6 hours of AMI onset.
- Outcomes assessed included mortality, MACE, LVEF, WMSI, and ventricular dimensions over a one-year follow-up.
Main Results:
- No significant differences in cardiovascular/all-cause mortality or MACE between groups.
- Significant improvements in left ventricle ejection fraction (LVEF) observed in both groups at one year.
- Statistically significant reductions in ventricular dimensions and WMSI were noted in both groups.
Conclusions:
- Dual RAS blockade demonstrates a beneficial effect on left ventricular function post-AMI in patients treated with primary PCI and stenting.
- This therapeutic approach did not increase cardiovascular mortality or non-fatal myocardial infarction incidence within the one-year follow-up period.
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