Table 3.
Studies of the initiation of ACE inhibitor therapy after acute myocardial infarction. * In GISSI-3, lisinopril had an open control rather than placebo and CONSENSUS II followed initial intravenous treatment.#
| Trial | Drug/ Dosage | Patients | Commenced/ Duration | Mortality |
|---|---|---|---|---|
| Unselected postinfarct patients | ||||
| CONSENSUS-II* | Enalapril | 6090 | Immediate | 11% vs 10.2% |
| [43] | 20 mg od | ST↑/Qs/↑enz | 6 months | RR −10% (P = 0.26) |
| GISSI-3* | Lisinopril | 18 895 | Up to 24 h | 6.3% vs 7.1% |
| [44] | 10 mg od | ST↑ | 6 weeks | RR 12% (2p = 0.03) |
| ISIS-4 | Captopril | 58 050 | Up to 24 h | 7.2% vs 7.7% |
| [45] | 50 mg bd | suspected MI | 5 weeks | RR 6% (2p = 0.02) |
| CCS-1 | Captopril | 13 634 | Up to 36 h | 9.1% vs 9.6% |
| [46] | 12.5 mg tds | suspected MI | 4 weeks | RR 6% (2p = 0.3) |
| Heart failure/high risk postinfarct patients | ||||
| SAVE | Captopril | 2231 | 3–16 days | 20% vs 25% |
| [47] | 50 mg tds | EF < 40% | 24–60 months | RR 19% (P = 0.02) |
| AIRE | Ramipril | 2006 | 3–10 days | 17% v. 23% |
| [48] | 5 mg bd | clinical heart failure | 6–30 months | RR 27% (P = 0.002) |
| TRACE | Trandolapril | 1749 | 3–7 days | 35% vs 42% |
| [49] | 4 mg od | EF < 35% | 24–50 months | RR 22% (P = 0.001) |
| SMILE | Zofenopril | 1556 | Within 24 h | 10.0% vs 14.1% |
| [50] | 30 mg bd | Anterior MI | 12 months # | RR 29% (P = 0.011) |
RR = relative risk reduction. EF = left ventricular ejection fraction.
#
Zofenopril treatment for 6 weeks only.