Carvedilol in combined therapy of patients with Q myocardial infarction

Aim. To evaluate effects of carvedilol (Akridilol, AKRIKHIN, Russia) on central hemodynamics, microvascular bed, hemorheology, von Willebrand factor (VWF) activity, clinical efficacy of the drug and influence on exercise tolerance in patients with Q myocardial infarction (QMI) compared to therapy with atenolol. Material and methods. The trial covered 90 patients with acute QMI. All the patients had cardiac failure and were divided into 3 comparable groups. Group I received carvedilol in a dose 625-50 mg/day. Group 2 received atenolol in a dose 12.5-50 mg/day. Group 3 had contraindications to therapy with beta-adrenoblockers. The patients were followed up for 60 +/- 2 days. The following methods were employed in the study: clinical examination, echocardiography, laser doppler flowmetry (LDF), Holter ECG monitoring, examination of platelet-vessel hemostasis, VWF activity, treadmill-test, statistical processing with the program Excel 7.0. Results. Inclusion of beta-adrenoblockers in combined therapy of QMI patients with cardiac failure considerably improves treatment efficacy. These drugs, carvedilol in particular, inhibit postinfarctional remodeling and thus development and progress of cardiac failure. Carvedilol reduces stasis in the microcirculatory bed, corrects abnormal response of microhemodynamics to sympathic activation and operation of venuloarteriolar mechanisms of capillary blood flow regulation. High clinical efficacy of the combined therapy of QMI patients is explained by marked antianginal and antiischemic effects of carvedilol. Treadmill test showed that the addition of beta-adrenoblockers to therapy raised exercise tolerance in the postinfarctional period.