GISSI-3 - EFFECTS OF LISINOPRIL AND TRANSDERMAL GLYCERYL TRINITRATE SINGLY AND TOGETHER ON 6-WEEK MORTALITY AND VENTRICULAR-FUNCTION AFTER ACUTE MYOCARDIAL-INFARCTION

Authors
DEVITA C FAZZINI PF GERACI E TAVAZZI L TOGNONI G VECCHIO C BOERI R DAMICO G LOI U MARUBINI E PAGLIARO L ROVELLI F FRANZOSI MG LATINI R MAGGIONI AP MAURI F VOLPI A BARLERA S NEGRI E NICOLIS E SANTORO E SANTORO L BONFANTI E CAPELLO T CASATI A CORATO A GARDINALE E NEGRINI M NOBILI A STASZEWSKY L TAVANELLI M TORTA D GAMBELLI G MORONI L PELLANDA JJ PIETROPAOLO F BALLI E BARBIERI A BECHI S CARRONE M CATANZARO M FASCIOLO L FRESCO C GHIANI A IACUITTI G LEDDA A LEVANTESI G PASINI P PECI P PIZZETTI F SAGONE A TURAZZA F VILLELLA A VILLELLA M BRAGGIO N DISERTORI M FREZZATI S GARATTINI S MARINO P MASERI A MAZZOTTA G NICOLOSI G PIRELLI S SANNA GP VALAGUSSA F DARGIE HJ PETO R POCOCK S SLEIGHT P YUSUF S GIORDANO F VARLESE A LOPARCO G IBERTI V GIAMUNDO L ANASTASI R PACIARONI E RAFFAELI S PURCARO A CIAMPANI N RITA E CUCCARONI G BALDINELLI A ALTIERI A GIORNETTI R AZZARO G FERRAGUTO P SALICI G LACONI E TIBURZI FM BERNARDI D LUNARDI M COLONNA L BOVENZI F AMODIO F SARCINA G CARPAGNANO A MATERA A MALACRIDA R RIGOTTI R DALLEMULE J DEBIASI A BRIDDA A INVERNIZZI G PITI A COLOMBO L TOMASSINI B BIASIA R SOLDA P SCARAMUZZINO G MIRRI A BRACCHETTI D DECASTRO U LINTNER W ERLICHER A GRONDA M DEVECCHI P GAGLIARDI RS BATTISTONI N STORELLI A GUADALUPI M NADOVEZZA S ZUFFIANO D DEPETRA V SCERVINO R TABACCHI G DESSALVI F SCORCU G GIARDINA G RAFFO M BOI W CAMMALLERI G GRUTTADAURIA G BALDINI F PAOLONE P PANTALEONI A CONTESSOTTO F DECONTI F PIGNATTI F FRIGNANI A IVALDI M ALETTO C PETTINATI G CIRICUGNO A MUSCELLA A CORREALE E ROMANO S DANDREA D MURENA E LONGOBARDI R DIMARTINO N PAOLINI E GADDI P CALVELLI C DULCETTI F GALASSI A COCO R COPPOLA A CENTAMORE G CALABRESE G SGALAMBRO G CIRCO A RACITI S DELLAMONICA R MALINCONICO M DEPONTI C PARMIGIANI ML BELLET C BORTOLINI F BUFFOLI L TIBERI A FERRARI A ROSSI A CIGLIA C DICENSO M MANGIAROTTI E ORNAGHI M DO V SPAPPERI D MAIOLINO P DELIO U CARROZZA A MARINONI C GUASCONI C SONNINO S PAGLIEI M FERRARI G POLITI A DELAZZARO M RINALDIS G CALCAGNILE A LUSETTI L BENDINELLI S MOLLAIOLI M COSMI F PLASTINA F MISURACA G SERAFINI O VENNERI N CATELLI P POLUZZI C BERGAMASCHI G FADIN MB DECHIARA F ZAMPAGLIONE G ELIA M RACCA E MEINARDI F CASASSO F BERTOCCHI P DONZELLI W PESSINA S TIRELLA G SAURO G TESSITORI M BINI A BARTOLETTI A AGNELLI D ZAGAMI A ANDREOLI L BASTONI L PUCCI P SANTINI A BUONAMICI PG FILICE M BADOLATI S ZERAUCHEK M DEMATTEIS D MAULUCCI G DANTUONO C LIBERTI R MENICONO L MATTOLI A TALLONE M DIVITA G MANCA G LICCI E CANZIANI R GUIDALI P RANCAN E MARIELLO F PENNETTA A MINELLI C BALDINI MR CAZZANI E ROMANO M BELLOTTI P CAMERINI A DAVI R PIAZZA R MUSSO G ROSSI P GIACCHERO C SEU V TOSELLI A DIGIACINTO N DICIO G SPANGHERO M CRESTI A SVETONI N BRUNO G DISTEFANO S GIOVANELLI N FINI M DETHOMATIS M PANDINI R CARRINO C GIAMMARIA M PISTELLI P RONZANI G OTTELLO B MELAPPIONI A ZAPPELLI L MARSILI P SCIMIA A RAGAZZINI G GRAMENZI S MOTTO A TULLIO D TUCCI D ROSSELLI P GAGGIOLI G BOLLINI R FAZIO AM RUSSO R BOSSI M SAVOIA M VALSECCHI MA BARBARESI F BARBIERO M BONOFIGLIO C GEMELLI M BONAGLIA M BOSSONI E LANZINI A DELBENE P CASCONE M ORLANDI M ODDONE A SALLAZZO V PANUCCIO D CANE G MOCCETTI T PASOTTI E TOGNOLI T CARAVITA L MAGGI A BARDELLI GC TUSA M MAGGI G GUERRA GP REGGIANI A IZZO A COLOMBO G FOTI F CONSOLO F ARRIGO F SACCA AM MAFRICI A ALBERTI A BELLI C DOSSENA MG SPINOLA A CASIRAGHI MG AZZOLLINI M POZZONI L SALMOIRAGO E MASSIRONI L SALA R BRESSI R RIGO R CAPPELLI S MALAVASI V PASCOTTO P PASQUAL AS SARTO P SANI F TOSONI D SPINNLER MT PERSICO D ORSI R LUGLIENGO V PAROLINI V ZILIO G SANDRI R NERI G ALITTO F PETRI D CUSA EN MAZZITELLI L PIANTADOSI FR DANIELLO L POLIMENO S MININNI N GRECO R BISCONTI C CUCCHIARI C DALLAVILLA W RANDON L ALLEGRI M MARCHI SM SANNA E DELUCA C MANETTA M DALLAVOLTA S MADDALENA F DONZELLI M PULISANO U DIMARIA B CELONA G MARCHI S VIVIRITO A CARRUBBA A LAMALFA RG SCHICCHI R BELLANCA G BATTAGLIA A CIRRINCIONE V RIBAUDO E STRIZZOLO L CARONE M DIGREGORIO D MANTINI L COREA L COCCHIERI M NOTARISTEFANO A CATANESE C FALEBURLE M SGARBI E CESARONI P BALDINI PM PAPI L LAVARINI L LORENZINI M TARDITI V MENARA N CONTI M FERRO M GIANOTTI A CRIVELLO R MICHELI G CONTI U CABANI E DAVINI P DELCITERNA F GIOMI A ALFIERI A CHITI M CODELUPPI P SMERIERI O DINAPOLI T CAPOZZOLI MR TOPI PL PAPERINI L TOPI A ZANUTTINI D NICOLOSI GL VISENTIN P CHARMET PA PETRELLA A BARDAZZI L NASSI F BIANCO GA CELLAMMARE G LICITRA R CINTOLO C SPADOLA V GUARRELLA L CASALI G MONDUCCI I ZOBBI G GUIDUCCI U CERRI P VIOLI E ROVELLI G TRIULZI E RUSCONI L SABATTINI R DESANCTIS A BOCK R ORAZI S PALMIERI M ROSSI F PESARESI A CIOPPI F PALAMARA A MANCINI P FERRAIUOLO G AZZOLINI P NEJA CP RISA MP BORGIA MC BORGIA C ZANCHI E RISA AL COLACE F TOZZI Q JESI AP TASSONI G VITUCCI NC LIRONCURTI C ALTIERI T VISCOMI A STRIANO U SALITURI S TARANTINO F GIRARDINI D ZONZIN P RONCON L FERRARESE E RAVERA B BUGATTI U PADULA G GIGANTINO A ALLEMANO P REYNAUD S FANELLI R DERITO V CROCE A GALLI M BERTOLI D VIVALDI F PEDRAZZINI F BARANI R DILEO M DORONZO B GAMBARATI GP ZOBBI M CARAMANNO G CRAPARO FG GIANI P ANTONGIOVANNI GB GRASSO V MOSSUTI E ROSELLA MG SKOUSE D GIUSTINIANI S CUCCHI G CONTI E FAGAGNINI L
Citation
C. Devita et al., GISSI-3 - EFFECTS OF LISINOPRIL AND TRANSDERMAL GLYCERYL TRINITRATE SINGLY AND TOGETHER ON 6-WEEK MORTALITY AND VENTRICULAR-FUNCTION AFTER ACUTE MYOCARDIAL-INFARCTION, Lancet, 343(8906), 1994, pp. 1115-1122
Citations number
29
Categorie Soggetti
Medicine, General & Internal
Journal title
Lancet → ACNP
ISSN journal
01406736
Volume
343
Issue
8906
Year of publication
1994
Pages
1115 - 1122
Database
ISI
SICI code
0140-6736(1994)343:8906<1115:G-EOLA>2.0.ZU;2-O
Abstract
GISSI-3 is a multicentre randomised clinical trial to assess the effic acy of lisinopril, transdermal glyceryl trinitrate (GTN), and their co mbination in improving survival and ventricular function after acute m yocardial infarction (AMI). Between June, 1991, and July, 1993, 19 394 patients were randomised from 200 coronary care units in Italy. Eligi ble patients presented within 24 h of symptom onset and had no clear i ndications for or against the study treatments. In a factorial design patients were randomly assigned 6 weeks of oral lisinopril (5 mg initi al dose and then 10 mg daily) or open control as well as nitrates (int ravenous for the first 24 h followed by transdermal GTN 10 mg daily) o r open control. Complete clinical data and 6-week follow-up were avail able for 18 895 (97.4%) patients randomised. Two-dimensional echocardi ographic data were available for 14 209 patients. Overall 6-week morta lity was 6.7%. Lisinopril, started within 24 h from AMI symptoms, prod uced significant reductions in overall mortality (odds ratio 0.88 [95% CI 0.79-0.99]) and in the combined outcome measure of mortality and s evere ventricular dysfunction (0.90 [0.84-0.98]). In the same trial th e systematic administration of transdermal GTN did not show any indepe ndent effect on the same outcome measures (0.94 [0.84-1.05] and 0.94 [ 0.87-1.02]). Systematic combined administration of lisinopril and GTN also produced significant reductions in overall mortality (0.83 [0.70- 0.97]) and in the combined endpoint (0.85 [0.76-0.94]). The favourable effect of lisinopril alone or with GTN was clear also in the predefin ed high-risk populations (elderly patients and women) for the combined endpoint. These findings were obtained in a population intensively ex posed to recommended treatments (thrombolysis 72%, beta-blockade 31%, and aspirin 84%); non-protocol treatment with angiotensin-converting-e nzyme inhibitors and nitrates was allowed for specific clinical indica tions. No excess of unfavourable clinically relevant events in the tre ated groups was reported.