ACE INHIBITORS POST-MI: THE PRACTICAL STUDY

A New Zealand study looking at effects of giving ACE inhibitor therapy very early after onset of symptoms of a heart attack has revealed that the drugs can be safely used while providing beneficial effects on left ventricular function. There is also a suggestion that favorable effects on mortality can be achieved using this therapy, as well as early indications that all ACE inhibitors may not be the same in this regard.

The results of the PRACTICAL study were presented by Hamid Ikram, head of cardiology at the Princess Margaret Hospital and the trial's chief investigator. The protocol called for very early enrollment of patients after onset of myocardial infarction symptoms, and the mean delay time was around ten hours. A total of 225 patients fulfilled the entry requirements, representing around 43% of those originally allocated for inclusion in the study.

The subjects were allocated to three treatment groups; placebo, Merck's enalapril or Bristol-Myers Squibb's captopril, with a background of appropriate conventional therapy. The primary endpoints were changes in left ventricular ejection fraction, left ventricular end-systolic and diastolic volume, circulating angiotensin II and blood pressure. The study was also geared towards providing mortality data, although the relatively small numbers of patients involved should be noted.