The dissertation presents the study of ramipril, perindopril or zofenopril effects on postinfarction remodeling of the heart, development of heart failure and survival rate of patients on the background of myocardial infarction (MI) complex therapy. The subject of increasing treatment efficiency in MI patients by differentiated use of Angiotensin-Converting Enzyme (ACE) inhibitors (ramipril, perindopril or zofenopril) in comorbidity condi-tions with arterial hypertension and diabetes mellitus was under study. 455 patients with sufficient ACE inhibi-tor compliance were examined to achieve this goal. All patients received basic MI therapy (statins, anticoagu-lants, antiplatelet agents, ß-adrenoblockers) and differed only in the administration of ACE inhibitors – rami-pril (group 1, n=232), perindopril (group 2, n=171) or zofenopril (group 3, n=52). Percutaneous coronary inter-vention was performed in 59 %. Clinical and functional-laboratory determination of efficacy application indi-ces of different compared ACE inhibitors in acute period of MI, and then in the remote postinfarction period, using the terms – the first day after the development of acute MI, 3 months and 24 months after MI was per-formed. By anthropometric, age, gender characteristics, risk factors, comorbidity indices, and initial clinical, la-boratory, and functional indices, inclination to treatment, groups were comparable. Studying the relationship of Nt-proBNP with the processes of postinfarction heart formation in the first three months after MI, we have re-vealed clear correlations with morpho-functional characteristics of the myocardium, according to dynamic echocardioscopy data, especially for ventricles size, myocardial wall thickness and its mass, systolic value of the left ventricle contraction. Nt-proBNP levels were decreased using all ACE inhibitors after 3 months of postinfarction period, but only in zofenopril group the reduction dynamics of this heart failure marker was sig-nificant (R2=0.895). Dynamic determination of Nt-proBNP during early post-infarction heart remodeling has optimized the choice of cardioprotective drugs, in particular ACE inhibitors, and identified preferences for the use of zofenopril in comorbid patients to prevent the development of chronic heart failure. Survival rate analy-sis after acute myocardial infarction was performed according to Kaplan-Meier method, the obtained graphical model of survival rate independent from cardiovascular occurrence in patients of the 1st,2nd,3rd groups was reli-able (χ2=17,74, p<0,001) with the best survival rate of zofenopril prescribed patients in acute period of MI. Di-agnostic significance of natriuretic peptides determination, especially Nt-proBNP for the detection of asymp-tomatic left ventricular dysfunction on the background of myocardial infarction in concomitant arterial hyper-tension and diabetes mellitus patients has been established. It is proved that Nt-proBNP dynamics during the first three months after myocardial infarction is significantly related to long-term prognosis of comorbid pa-tient’s survival rate. Optimal hemodynamic profile was established in prescribing zofenopril from the first day of myocardial infarction – no initial sharp decrease in arterial blood pressure and significant variations of heart rate, prevention of myocardial infarction expansion by the dynamics of echocardioscopic indices of postinfarc-tion heart remodeling in prolonged observation perspective up to 24 months. Better antiischemic activity was confirmed in zofenopril comparing with the studied ACE inhibitors – ramipril and especially perindopril, that was manifested by a lower incidence of postinfarction angina pectoris and in minimal need for additional ad-ministration of nitrates to relieve and prevent pain syndrome. For the first time, a comparative analysis of long-term survival rate after myocardial infarction was performed by direct comparison of three ACE inhibitors – ramipril, perindopril and zofenopril, which have the largest evidence base of use in myocardial infarction. Pref-erences of zofenopril choice for complex therapy of myocardial infarction in comorbidity with arterial hyper-tension and diabetes mellitus are substantiated.
