Concomitant Angiotensin-Converting Enzyme Inhibition and Thrombolysis in Acute Anterior Myocardial Infarction:

Left ventricular (LV) dilatation after myocardial infarction markedly increases mortality. Because LV dilatation begins very soon after coronary occlusion, therapy aimed at inhibiting dilatation optimally should be initiated very soon after infarction. Ventricular unloading through angiotensin-converting enzyme (ACE) inhibition is promising therapy for reducing early and late ventricular dilatation. Although thrombolytic therapy with reperfusion may salvage myocardium, reduce LV dilatation, and reduce mortality, dilatation and aneurysm formation still occur, especially when reperfusion is delayed or inadequate. Accordingly, the Captopril Plus t-PA in Acute Myocardial Infarction Trial was designed to assess the potential beneficial effect of very early intravenous ACE inhibition with captopril when used in combination with tissue plasminogen activator in acute anterior myocardial infarction.