Concentration-Dependent Protection by Captopril Against Myocardial Damage During Ischemia and Reperfusion in a Closed Chest Pig Model

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We previously reported concentration-dependent protection of captopril against ischemia-reperfusion injury in the isolated rat heart. In order to study these effects in vivo, we developed a closed-chest pig model. Reversible occlusion of the left coronary artery was achieved with a PTCA catheter during one hour. Captopril (C) i.v. was given in two different concentrations (0.6 mg/kg/10min + 0.3 mg/kg/2 hr and 6 mg/kg/10 min + 3.0 mg/kg/2 hr) timing the experiments to II and 10 pigs. respectively, versus 12 controls, who received only saline. Due to malignant ventricular arrhythmias, nine pigs died during ischemia. At the end of the reperfusion period of two hours, eight pigs were alive in each group. In the entreated pigs, maximum creatine kinase after two hours of reperfusion was significantly lowered to 6.337 ± 709 U/L in the high dose group versus 8.285 ± 851 U/L in the low dose group and 9.635 ± 1,115 U/L in the saline group. A reduction of local inosine overflow in the coronary sinus was seen. Maximum noradrenaline overtlow after 5 min reperfusion diminished dose-dependently to 695 ± 284 and 3,129 ± 1.728 pg/ml in the C treated groups versus 4.693 ± 2,277 pg/ml in the saline group. Mean arterial blood pressure and cardiac output decreased significantly during ischemia and reperfusion, but no significant differences occurred between the treated and untreated groups. Reperfusion arrhythmias, mainly accelerated idioventricular rhythm disturbances, were comparable among the three groups. We conclude that in vivo administration of C reduces myocardial damage upon reperfusion after one hour of ischemia in a dose-dependent way. It is suggested that direct myocardial effects play an important role in the underlying mechanism.

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