Captopril and Thrombolysis Study - CATS

Description:

Captopril vs. placebo for preventing left ventricular dilation after anterior MI.

Hypothesis:

Captopril administered early after anterior infarction treated with thrombolytic therapy will reduce morbidity by preventing left ventricular dilation and neurohormonal perturbation.

Study Design

Patients Screened: Not given
Patients Enrolled: 298
Mean Follow Up: 12 months
Mean Patient Age: 60
Female: 25

Patient Populations:

Patients with first anterior wall myocardial infarction treated with streptokinase.

Exclusions:

Blood pressure > 200 or < 100 mm Hg
Cardiogenic shock
Intolerance of ACE inhibitors
Requirement for beta blockers

Primary Endpoints:

Development of heart failure

Secondary Endpoints:

Echocardiographic chamber dimensions

Drug/Procedures Used:

Captopril 25mg tid (titrated from 6.25mg)
Streptokinase 1.5 million units

Concomitant Medications:

Beta blocker (18%)
Calcium channel blockers (14%)
Diuretics (12%)
Nitrates (10%)

Principal Findings:

Incidence of heart failure reduced in the captopril group (p = 0.36).

Observation not paralleled by a reduction in average left ventricular volumes.

Significant effect of captopril on progression of dilation demonstrated only in patients with medium-sized infarcts.

If dilation had already occurred, progression to symptomatic heart failure was not significantly affected by captopril.

Interpretation:

Ventricular enlargement after anterior myocardial infarction treated with streptokinase is mostly an early phenomenon. Treatment with captopril prevents the progression to dilation in moderate sized infarcts. Patients with large infarcts still dilate despite treatment. Early ACE inhibitor therapy after myocardial infarction may be critical to decrease subsequent morbidity.

References:

1. Herz. 1993;18 Suppl 1:416-23>. Design
2. Eur Heart J 1994;15:898-907. Final results
3. J Am Coll Cardiol 1996;28:114-21. 1-year echo follow up

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Thrombolytic Therapy, Streptokinase, Heart Failure, Fibrinolytic Agents, Anterior Wall Myocardial Infarction, Captopril


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