Long-term mortality in patients with myocardial infarction: impact of early treatment with captopril for 4 weeks

Objective In an earlier interim report of the Chinese Cardiac Study (CCS-1) trial, 15 000 patients up to 36 hours after the onset of suspected acute m yocardial infarction (AMI) were randomized to receive either oral captopril or matching placebo for one month. Results showed that captopril was assoc iated with a nonsignificant reduction in 4-week mortality (681 [9.1%] capto pril-allocated vs 730 [9.7%] placebo-allocated deaths; 2P=0.19), but the lo ng-term effects remained uncertain. The present study reports, on the longt erm effect of early captopril treatment on mortality and other major events in AMI patients of the earlier CCS-1 trial. Methods Long-term follow-up was carried out in those hospitals which had re cruited more than 20 cases in the CCS-1 trial. 8000 patients with MI were t hus selected for long-term follow-up. Data on 6749 patients (84.4%) were av ailable. Results Patient characteristics were comparable between the treatment group (n = 3391) and the placebo group (n = 3358). Average follow-up time was 23 .4 +/- 16.9 months; average age was 63.6 +/- 10.6 years, and 76.2% were mal e. At the end of the follow-up time, cardiac function of NYHA III-IV was 9. 0% in the treatment group and 9.8% in the placebo group; the reinfarction r ate was 5.6% vs. 6.0%; total cardiovascular events were 32.9% vs. 34.3%. To tal mortality was 11.9% (n = 404) vs 13.8% (n = 463), with a 13.8% reductio n in the captopril group (P=0.03). Cardiovascular mortality was 10.0% vs. 1 1.8% ( P = 0.01), death due to heart failure was 4.1% vs. 5.5% ( P = 0.01). From the above results, it is estimated that early treatment with captopri l can save 19 lives per 1000 patients treated; patients with systolic blood pressure (SBP) greater than or equal to 100) mm Hg at entry would have a l ong-term mortality 12.4% in the treatment group vs. 13.8% in the placebo gr oup (P=0.04) and patients with a heart rate (HR) greater than or equal to 6 0/minute at entry would have a long term mortality 12.0% in captopril group s vs. 14.5% in the placebo group (P=0.01). Conclusion Early treatment with captopril during AMI for 4 weeks can signif icantly reduce long-term total mortality.