TY - JOUR
T1 - Prognostic value of neurohumoral activation in patients with an acute myocardial infarction
T2 - Effect of captopril
AU - Rouleau, Jean Lucien
AU - Packer, Milton
AU - Moyé, Lemuel
AU - de Champlain, Jacques
AU - Bichet, Daniel
AU - Klein, Marc
AU - Rouleau, Jacques R.
AU - Sussex, Bruce
AU - Arnold, J. Malcolm
AU - Sestier, François
AU - Parker, John O.
AU - McEwan, Patricia
AU - Bernstein, Victoria
AU - Cuddy, T. Edward
AU - Lamas, Gervasio
AU - Gottlieb, Stephen S.
AU - McCans, John
AU - Nadeau, Claude
AU - Delage, François
AU - Wun, Chuan Chuan C
AU - Pfeffer, Marc A.
N1 - Funding Information:
Montreal, Quebec, Canada; 'Institut de Cardiologie de Quebec, Quebec, Canada; "Memorial University, St. John's, Newfoundland, Canada; 'Victoria Hospital, London, Ontario, Canada ; 'HOpital Notre-Dame de Montreal, Montreal, Quebec, Canada; ''Kingston General Hospital, Kingston, Ontario, Canada ; "The Wellesley Hospital, Toronto, Ontario, Canada; "University of British Columbia, Vancouver, British Columbia, Canada ; `University of Manitoba, Winnipeg, Manitoba, Canada : "Mount Sinai Medical Center, Miami, Florida ; `1-16tel-Dieu de Levis, Levis, Quebec, Canada ; `1-16pital de I'Enfam-Jesus, Quebec, Canada ; "Brigham and Women's Hospital, Boston, Massachusetts ; "University of Maryland Hospital, Baltimore, Maryland; "Jewish General Hospital, Montreal, Quebec, Canada. This study was supported by the Medical Research Council of Canada, Ottawa, Ontario and by Bristol-Myers Squibb Laboratories of Canada, Montreal, Quebec, Canada . Manuscript received October 18,1993 ; revised manuscript received February 18, 1994, accepted May 4, 1994 . Address for correspondence : Dr. Jean-Lucien Rouleau, Montreal Heart Institute, 5000, Belanger Street East, Montreal, Quebec, Canada HiT 1C8.
PY - 1994/9
Y1 - 1994/9
N2 - Objectives. This study attempted to evaluate whether neurohumoral activation at the time of hospital discharge in postinfarction patients helps to predict long-term prognosis and whether long-term therapy with the angiotensin-converting enzyme inhibitor captopril modifies this relation. Background. Neurohumoral activation persists at the time of hospital discharge in a large number of postinfarction patients. The Survival and Ventricular Enlargement (SAVE) study demonstrated that the angiotensin-converting enzyme inhibitor captopril improves survival and decreases the development of severe heart failure in patients with left ventricular dysfunction (left ventricular ejection fraction ≤40%) but no overt postinfarction heart failure. Methods. In 534 patients in the SAVE study, plasma neurohormone levels were measured a mean of 12 days after infarction. Patients were then randomized to receive captopril or placebo and were followed up for a mean (±SD) of 38 ± 6 months (range 24 to 55). The association between activation of plasma neurohormones at baseline and subsequent cardiovascular mortality or the development of heart failure was assessed with and without adjustment for other important prognostic factors. Results. By univariate analysis, activation of plasma renin activity and aldosterone, norepinephrine, atrial natriuretic peptide and arginine vasopressin levels were related to subsequent cardiovascular events, whereas epinephrine and dopamine levels were not. By multivariate analysis, only plasma renin activity (relative risk 1.6, 95% confidence interval [CI] 1.0 to 2.5) and atrial natriuretic peptide (relative risk 2.2, 95% CI 1.3 to 3.8) were independently predictive of cardiovascular mortality, whereas the other neurohormones were not. Only plasma renin activity and aldosterone, atrial natriuretic peptide and arginine vasopressin were independent predictors of the combined end points of cardiovascular mortality, development of severe heart failure or recurrent myocardial infarction. Except for 1-year cardiovascular mortality, the use of captopril did not significantly modify these relations. Conclusions. Neurohumoral activation at the time of hospital discharge in postinfarction patients is an independent sign of poor prognosis. This is particularly true for plasma renin activity and atrial natriuretic peptide. Except for 1-year cardiovascular mortality, captopril does not significantly modify these relations.
AB - Objectives. This study attempted to evaluate whether neurohumoral activation at the time of hospital discharge in postinfarction patients helps to predict long-term prognosis and whether long-term therapy with the angiotensin-converting enzyme inhibitor captopril modifies this relation. Background. Neurohumoral activation persists at the time of hospital discharge in a large number of postinfarction patients. The Survival and Ventricular Enlargement (SAVE) study demonstrated that the angiotensin-converting enzyme inhibitor captopril improves survival and decreases the development of severe heart failure in patients with left ventricular dysfunction (left ventricular ejection fraction ≤40%) but no overt postinfarction heart failure. Methods. In 534 patients in the SAVE study, plasma neurohormone levels were measured a mean of 12 days after infarction. Patients were then randomized to receive captopril or placebo and were followed up for a mean (±SD) of 38 ± 6 months (range 24 to 55). The association between activation of plasma neurohormones at baseline and subsequent cardiovascular mortality or the development of heart failure was assessed with and without adjustment for other important prognostic factors. Results. By univariate analysis, activation of plasma renin activity and aldosterone, norepinephrine, atrial natriuretic peptide and arginine vasopressin levels were related to subsequent cardiovascular events, whereas epinephrine and dopamine levels were not. By multivariate analysis, only plasma renin activity (relative risk 1.6, 95% confidence interval [CI] 1.0 to 2.5) and atrial natriuretic peptide (relative risk 2.2, 95% CI 1.3 to 3.8) were independently predictive of cardiovascular mortality, whereas the other neurohormones were not. Only plasma renin activity and aldosterone, atrial natriuretic peptide and arginine vasopressin were independent predictors of the combined end points of cardiovascular mortality, development of severe heart failure or recurrent myocardial infarction. Except for 1-year cardiovascular mortality, the use of captopril did not significantly modify these relations. Conclusions. Neurohumoral activation at the time of hospital discharge in postinfarction patients is an independent sign of poor prognosis. This is particularly true for plasma renin activity and atrial natriuretic peptide. Except for 1-year cardiovascular mortality, captopril does not significantly modify these relations.
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U2 - 10.1016/0735-1097(94)90001-9
DO - 10.1016/0735-1097(94)90001-9
M3 - Article
C2 - 7915733
AN - SCOPUS:0028017360
VL - 24
SP - 583
EP - 591
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 3
ER -