赖诺普利。回顾其药理学和临床疗效在急性心肌梗死的早期管理。

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果阿KL、贝尔福JA Zuanetti G

赖诺普利。回顾其药理学和临床疗效在急性心肌梗死的早期管理。

药。1996年10月,52 (4):564 - 88。doi: 10.2165 / 00003495-199652040-00011。

PubMed ID
8891468 (在PubMed
]
文摘

后建立高血压和充血性心力衰竭的疗效,ACE抑制剂赖诺普利已被证明能降低死亡率和心血管发病率在心肌梗死患者进行早期治疗。赖诺普利的能力减弱的不利影响左心室重塑是一个关键机制;然而,额外的心血管和vasculoprotective行动提出发挥调停作用早期的好处。> 19中的GISSI-3试验000例证明,当口服在24小时内出现症状,持续了6周,赖诺普利(有或没有硝酸盐)产生可衡量的生存利益在1到2天内开始治疗。没有赖诺普利治疗相比,减少死亡率的风险在11%和7.7%的复合终点(死亡和严重的左心室功能障碍)在6周明显。在所有类型的优势是明显的病人。因此,那些在高风险妇女、老年人、糖尿病患者和那些前梗塞克利斯和/或还注重类> 1也受益。这些成果在联合终点事件持续从长远来看,尽管大多数患者治疗6周后退出。在6个月,对合并后的端点的发生率仍然低于与控制(减少了6.2%)。GISSI-3结果一致与最近的大型调查(ISIS-4 CCS-1,微笑)心肌梗死早期管理的其他血管紧张素转换酶抑制剂。 However, the results of the CONSENSUS II trial (using intravenous enalaprilat then oral enalapril) were unfavourable in some patients. These findings, together with the development of persistent hypotension and, to a lesser extent, renal dysfunction among patients in the GISSI-3 trial, have prompted considerable debate over optimum treatment strategies. Present opinion generally holds that therapy with lisinopril or other ACE inhibitors shown to be beneficial may be started within 24 hours in haemodynamically stable patients with no other contraindications; current labelling in the US and other countries reflects this position. There is virtually unanimous agreement that such therapy is indicated in high-risk patients, particularly those with left ventricular dysfunction. The choice of ACE inhibitor appears less important than the decision to treat; it seems likely that these benefits are a class effect. Lisinopril has a tolerability profile resembling that of other ACE inhibitors, can be given once daily and may be less costly than other members of its class. However, present cost analyses are flawed and this latter points remains to be proven in formal cost-effectiveness analyses. In conclusion, early treatment with lisinopril (within 24 hours of symptom onset) for 6 weeks improves survival and reduces cardiovascular morbidity in patients with myocardial infarction, and confers ongoing benefit after drug withdrawal. While patients with symptoms of left ventricular dysfunction are prime candidates for treatment, all those who are haemodynamically stable with no other contraindications are also eligible to receive therapy. Lisinopril and other ACE inhibitors shown to be beneficial should therefore be considered an integral part of the early management of myocardial infarction in suitable patients.

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