EFFECT OF THE ACE-INHIBITOR LISINOPRIL ON MORTALITY IN DIABETIC-PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION - DATA FROM THE GISSI-3 STUDY

Background Mortality of diabetic patients with acute myocardial infarc tion (MI) remains high despite recent improvement in their management. There is a need to evaluate efficacy and safety of novel treatments o f MI in this high-risk population, We evaluated whether treatment with an ACE inhibitor begun within 24 hours from the onset of symptoms is able to decrease mortality and morbidity of diabetic patients with acu te MI. Methods and Results A retrospective analysis of the data of the GISSI-3 study in patients with and without a history of diabetes was performed. Patients with suspected acute MI were randomized to treatme nt with lisinopril (2.5 to 5 up to 10 mg/d) with or without nitroglyce rin (5 to 20 mu g IV then 10 mg/d) begun within 24 hours and continued for 6 weeks. The main end point was mortality at 6 weeks, and the sec ondary end point was a combined evaluation of mortality and severe lef t ventricular dysfunction. Information on diabetic status was availabl e for 18 131 patients (approximate to 94% of the total population enro lled), of whom 2790 patients had a history of diabetes. Treatment with lisinopril was associated with a decreased 6-week mortality in diabet ic patients (8.7% versus 12.4%; OR, 0.68; 95% CI, 0.53 to 0.86; 37+/-1 2 lives saved per 1000 treated patients), an effect that was significa ntly (P<.025) higher than that observed in nondiabetic patients. The s urvival benefit in diabetics was mostly maintained at 6 months despite withdrawal from treatment at 6 weeks (12.9% versus 16.1%; OR, 0.77; 9 5% CI, 0.62 to 0.95). Conclusions Early treatment with the ACE inhibit or lisinopril in diabetic patients with acute MI is associated with a decreased 6-week mortality. This beneficial effect supports a widespre ad and early use of ACE inhibitors in diabetic patients with acute MI. The burden of mortality plus morbidity for ventricular dysfunction in diabetics remains clinically important and warrants further testing o f novel therapeutic approaches.