Postmyocardial infarction patients: experience from the SAVE trial.

Improving patient survival is the ultimate goal after acute myocardial infarction. Although thrombolytics, aspirin, and beta-blockers have greatly decreased mortality, structural changes such as ventricular dilatation evolving within the myocardium during and after acute myocardial infarction indicate a poor prognosis. The Survival and Ventricular Enlargement trial demonstrated that when administered 3 to 16 days after acute myocardial infarction in selected patients, captopril, the angiotensin-converting enzyme inhibitor, reduces ventricular dilatation, prevents the development of congestive heart failure, and reduces morbidity and mortality. This paper reviews results of that trial and presents guidelines for effective captopril dosage after acute myocardial infarction.

Stability of time-tradeoff utilities in survivors of myocardial infarction.

To investigate whether time-tradeoff utilities of survivors of myocardial infarction change over time and whether changes in utilities correlate with changes in functional status, the authors conducted serial interviews using a time tradeoff and three measures of functional status in a cohort of 67 patients who had recently had myocardial infarction. The patients were also asked to rate their overall health on a rating scale and were asked about chest pain, exercise status, and employment status. Each patient was interviewed two to five times over one and a half years. The mean (95% CI) time-tradeoff score for all patients was 0.88 (0.84, 0.93). Over a mean interval of 8.4 months, 28 (42%) patients changed Karnofsky scores, 28 (42%) changed Specific Activity Scale classes, and 11 (16%) changed New York Heart Association classes, with most changes representing improvements in functional status. Scores on the rating scale improved by a mean (95% CI) of 0.06 [(0.03, 0.10); p < 0.002], but scores on the time tradeoff remained stable, with a mean (95% CI) change of 0.03 [(-0.02, 0.08); p = NS]. Changes in time-tradeoff scores did not correlate with changes in Specific Activity Scale classes (Kendall's tau = 0.21), New York Heart Association classes (tau = -0.02), or Karnofsky scores (tau = 0.14); with changes on the verbal rating scale (R = 0.20); with changes in chest pain status (tau = -0.05), exercise status (tau = 0.11), or employment status (tau = 0.11); or with interim hospitalizations (tau = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)