PRESTIGE study: ACE inhibitors efficacy in patients with acute myocardial infarction and left ventricular dysfunction

Aim. The principal objective of this randomized, comparative, open clinical trial PRESTIGE was to determine the time of achieving optimal therapeutic dozes of ACE inhibitors. The secondary goal was to assess dynamics of chronic heart failure (CHF) functional classes (FC) during the treatment.
Material and methods. The study involved 125 patients with Q-wave acute myocardial infarction (MI): 68 males, 57 females; mean age 67 years. All participants were randomized into perindopril or captropril groups (n=63 and 62, respectively). In dose titration, starting doses were 2 mg/d and 18.75 mg/d, respectively. Recommended daily doses were 4-8 mg once per day for perindopril, and 75-150 mg, three times per day, for captropril. Treatment and follow-up period lasted for 6 months. ACE inhibitor efficacy was assessed by measuring brain natriuretic peptide (BNUP) levels - at baseline, Weeks 8 and 24. Quality of life (QoL) was assessed by two methods: by “health line” and standard Minnesota University Questionnaire for heart failure patients. Incidence of death and hospitalization due to cardiovascular causes was also registered.
Results. At Week 8, there was a significant reduction in BNUP level (to 296.5±16.7 pmmol/l; or by 25.4%; р=0.004) in perindorpil group, and to 342.7±13.8 pmmol/ml (by 19.1%; NS; р=0.06) in captopril group. At 6 months, QoL improved in perindopril group (reduced total QoL score, 23.8; р=0.047), and did not change comparing to Week 3, in captopril group (31.4).
Conclusion. MI patients with left ventricular dysfunction, early administered ACE inhibitors, achieved target dose of perindopril faster than that of captopril. That was associated with improved clinical course (CHF FC, QoL) in perindopril group.

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