卡托普利对前壁与下壁心肌梗塞作用差异的临床试验

Difference in the effects of captopril on anterior and inferior myocardial infarction

报告中国转换酶抑制剂治疗急性心肌梗塞多中心随机双盲安慰剂对照临床试验的一部分，重点探讨卡托普利对前壁与下壁心肌梗塞作用的差异。选择急性心肌梗塞患者１２６３１例，随机分配到卡托普利治疗组或安慰剂对照组，口服卡托普利或安慰剂１２．５ｍｇ３次／ｄ，治疗４周。结果提示：前壁梗塞（ｎ＝６０５７）治疗组４周病死率（９．２％）明显低于对照组（１０．８％），减少死亡危险１５％（Ｐ＝０．０４），但下壁梗塞（ｎ＝３９９０）病死率治疗组（７．２％）与对照组（６．７％）差异无显著性（Ｐ＝０．５４）。发病６ｈ内入选前壁梗塞病死率治疗组（９．５％）显著低于对照组（１３．２％）（Ｐ＝０．００４），但下壁无此差异。非心动过缓（心率≥６０次／分）者总病死率治疗组（９．５％）明显低于对照组（１１．５％；Ｐ＝０．０４），在前壁尤为显著（治疗组８．６％；对照组１２．５％，Ｐ＝０．００１）。结果表明：卡托普利早期治疗前壁心肌梗塞是安全和有益的，但对下壁则无益。

Abstract This report is a part of the Chinese CEI-AMI clinical trial which was aimed to investigate the difference in the effects of treatment of patients with anterior and inferior acute myocardial infarction (AMI) by captopril.A total of 12631 cases with AMI within 36 hours after onset of pain were randomized into captopril group (CG) and placebo group (PG). Patients took either captopril or placebo, 12.5 mg tid for 4 weeks, during which in anterior wall infarction (AWI)(n=6057) the death rate in CG was 9. 2% which was significantly lower than that of 10. 8% in PG with a reduction in death risk of 15%(P=0. 04), but in inferior wall infarction (IWI) (n=3990), the death rates were 7. 2%and 6. 7% in CG and PG, respectively (P=0. 54). Among the AWI patients enrolled 0-6 h after onset ofpain the mortality in CG (8. 4%) was markedly lower than that in PG (13. 2%; P= 0. 004), but no difference was found in the IWI. In cases without bradycardia (HE≥60 beat/min), the mortality in CG(9. 5%) was markedly lower than that in PG (11. 5%; P = 0. 04 ) ;especially in the AWI (8. 6% vs 12. 5%; P=0. 001).In the AWI , the incidences of heart arrest and ventricular fibrillation were lower in CG than in PG; 8. 6% and 6. 1% of the patients in IWI and AWI, respectively,had to stop medication because of hypotension (P<0. 01). The results suggest that early treatment with captopril is safe and beneficial in patients with AWI,but not in those with IWI.