Usporedba učinaka losartana i ramiprila u liječenju akutnoga infarkta srca s elevacijom ST spojnice [The comparison of the efficacy of ramipril and losartan in treatment of ST-elevation myocardial infarction]

Marinšek, Martin (2017) Usporedba učinaka losartana i ramiprila u liječenju akutnoga infarkta srca s elevacijom ST spojnice [The comparison of the efficacy of ramipril and losartan in treatment of ST-elevation myocardial infarction]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Objectives. The use of an angiotensin-converting enzyme inhibitor (ACE-I) or an angiotensinreceptor antagonists (ARBs) reduces the incidence of heart failure and the risk of thrombosis after acute ST-elevation myocardial infarction (STEMI) blockade of the renin-angiotensinaldosterone system (RAAS).There are some differences between ACE-I and ARBs, as more than 75% of angiotensin II in human myocardium originates from the alternative pathway influenced only by ARB. Goal. To compare the effect of 8-week and 6-month treatment of AMI patients with ramipril and losartan on laboratory markers, echocardiographic parameters and clinical signs of heart failure. Patients and methods.108 patients who suffered an STEMI were randomized in a ramipril (55) and a losartan (53) group, and followed-up for 8 weeks and 6 months. During treatment the effect of drugs on clinical (Killip-Kimbal classes), laboratory markers (NT-pro BNP, PAI-1, lipidogram) and echocardiographical parameters (EFLV, LVEDD) were compared. Results. No statistically significant differences in the levels of laboratory markers, echocardiographic parameters and clinical signs of heart failure were observed between the ramipril and the losartan group, neither after 8-week nor after 6-month treatment. Conclusions. After an uncomplicated STEMI, losartan was equally effective as ramipril in terms of laboratory markers, echocardiographic parameters and clinical signs of heart failure.

Abstract in Croatian

Polazište. Nakon akutnoga infarkta miokarda s elevacijom ST spojnice (STEMI) blokada reninangiotenzinskoga sustava (RAS) putem inhibitora angiotenzin-konvertirajućega enzima (ACE-I) ili blokatora receptora angiotenzina II (ARB) smanjuje pojavu zatajenja srca i sklonost trombozi. Između djelovanja ACE-I-ja i ARB-a postoje razlike jer više od 75 % angiotenzina II u ljudskome miokardu nastaje alternativnim putom na koji ACE-I ne utječe. Cilj. Usporedba učinka liječenja bolesnika sa STEMI-jem ramiprilom i losartanom u razdoblju od 8 tjedana i 6 mjeseci s pomoću laboratorijskih biljega, kliničkih znakova i ehokardiografskih parametara zatajenja srca. Ispitanici i metode. 108 bolesnika nakon STEMI-ja randomizano je u skupinu od 55 bolesnika liječenih ramiprilom i skupinu od 53 bolesnika liječenih losartanom i praćeni su 8 tjedana, a 55 bolesnika i za 6 mjeseci. Tijekom liječenja uspoređen je utjecaj lijekova na kliničke znakove zatajenja srca (Killip-Kimballova kategorizacija), laboratorijske biljege (NT-proBNP, PAI-1, lipidogram) i ehokardiografske parametre zatajenja srca (EFLV, LVEDD). Rezultati. Između ramiprilske i losartanske skupine bolesnika nije utvrđena statistički značajna razlika u vrijednostima laboratorijskih biljega, ehokardiografskih parametara i kliničkih znakova zatajenja srca nakon 8 tjedana i nakon 6 mjeseci liječenja. Zaključak. Nakon nekompliciranoga STEMI-ja losartan je podjednako učinkovit kao ramipril u pogledu laboratorijskih biljega, ehokardiografskih parametara i kliničkih znakova zatajenja srca.

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