RESUMEN
AIMS: Elevated natriuretic peptides (NPs) are associated with an increased cardiovascular risk following acute coronary syndromes (ACSs). However, the therapeutic implications are still undefined. We hypothesized that early inhibition of renin-angiotensin-aldosterone system (RAAS) in patients with preserved left ventricular function but elevated NPs but following ACS would reduce haemodynamic stress as reflected by a greater reduction NP compared with placebo. METHODS AND RESULTS: AVANT GARDE-TIMI 43 trial, a multinational, double-blind trial, randomized 1101 patients stabilized after ACS without clinical evidence of heart failure or left ventricular function Asunto(s)
Síndrome Coronario Agudo/tratamiento farmacológico
, Amidas/uso terapéutico
, Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico
, Fumaratos/uso terapéutico
, Péptido Natriurético Encefálico/metabolismo
, Fragmentos de Péptidos/metabolismo
, Tetrazoles/uso terapéutico
, Valina/análogos & derivados
, Síndrome Coronario Agudo/sangre
, Anciano
, Análisis de Varianza
, Presión Sanguínea/efectos de los fármacos
, Muerte Súbita Cardíaca/etiología
, Método Doble Ciego
, Femenino
, Hospitalización
, Humanos
, Masculino
, Persona de Mediana Edad
, Infarto del Miocardio/sangre
, Infarto del Miocardio/etiología
, Renina/antagonistas & inhibidores
, Sistema Renina-Angiotensina/efectos de los fármacos
, Valina/uso terapéutico
, Valsartán
RESUMEN
AIMS: There is a large body of evidence that reactive oxygen species (ROS) produced during myocardial ischemia and reperfusion play a crucial role in myocardial damage and endothelial dysfunction. The MIVIT pilot trial was designed to test the effects of antioxidant vitamins C and E on the clinical outcome of patients with AMI. METHODS AND RESULTS: In this randomized, double-blind, multicenter trial, 800 patients (mean age 62) with AMI were randomly allocated to receive, on top of routine medication, one of two treatments: vitamin C (1000 mg/12 h infusion) followed by 1200 mg/24 h orally and vitamin E (600 mg/24 h) or matching placebo for 30 days. Primary end point (composite of in-hospital cardiac mortality, non-fatal new myocardial infarction, VT/VF/asystole, shock/pulmonary edema) occurred less frequently in patients treated with antioxidants (55 [14%] vs 75 [19%], OR 0.82 [95% CI, 0.68-1.00], p=0.048). CONCLUSIONS: This randomized pilot trial shows that supplementation with antioxidant vitamins is safe and seems to positively influence the clinical outcome of patients with AMI. A larger study is warranted to provide further evidence of this promising and inexpensive regimen.