INDICATIONS FOR ACE-INHIBITORS IN THE EARLY TREATMENT OF ACUTE MYOCARDIAL-INFARCTION - SYSTEMATIC OVERVIEW OF INDIVIDUAL DATA FROM 100,000 PATIENTS IN RANDOMIZED TRIALS
Mg. Franzosi et al., INDICATIONS FOR ACE-INHIBITORS IN THE EARLY TREATMENT OF ACUTE MYOCARDIAL-INFARCTION - SYSTEMATIC OVERVIEW OF INDIVIDUAL DATA FROM 100,000 PATIENTS IN RANDOMIZED TRIALS, Circulation, 97(22), 1998, pp. 2202-2212
Citations number
33
Categorie Soggetti
Peripheal Vascular Diseas",Hematology,"Cardiac & Cardiovascular System
Background-Several large-scale trials have demonstrated improved survi
val with ACE-inhibitor therapy started during acute myocardial infarct
ion. A systematic overview was conducted to resolve uncertainties rega
rding time of initiation, time course of effect, and identification of
patients in whom the benefits or the risks may be greater. Methods an
d Results-This overview aimed to include individual data from all rand
omized trials involving more than 1000 patients in which ACE-inhibitor
treatment was started in the acute phase (0 to 36 hours) of myocardia
l infarction and continued for a short time (4 to 6 weeks). Data were
available for 98496 patients from 4 eligible trials, and the results w
ere consistent among the trials. Thirty-day mortality was 7.1% among p
atients allocated to ACE inhibitors and 7.6% among control subjects, c
orresponding to a 7% (SD, 2%) proportional reduction (95% CI, 2% to 11
%; 2P < 0.004). This represented avoidance of approximate to 5 (SD, 2)
deaths per 1000 patients, with most of the benefit observed within th
e first week. The proportional benefit was similar in patients at diff
erent underlying risk. The absolute benefit was particularly large in
some high-risk groups tie, Killip class 2 to 3, heart rate greater tha
n or equal to 100 bpm at entry) and in anterior MI. ACE-inhibitor ther
apy also reduced the incidence of nonfatal cardiac failure (14.6% vers
us 15.2%, 2P = 0.01) but was associated with an excess of persistent h
ypotension (17.6% versus 9.3%, 2P < 0.01) and renal dysfunction (1.3%
versus 0.6%, 2P < 0.01). Conclusions-These results support the use of
ACE inhibitors early in the treatment of acute MI, either to a wide ra
nge of patients or selectively in patients with anterior MI and in tho
se at increased risk of death.