Table 2.
Effect of ACEI/ARB on AMI
| Trial acronym (year of publication) | Population | Patient no. | Comparators | Mean follow-up duration | Major results |
|---|---|---|---|---|---|
| ACEI | |||||
| ISIS-4 (1995) ISIS-4 Collaborative Group, 1995 | AMI | 58 050 | Captopril (6.25 mg daily up to 50 mg twice daily) versus placebo | 15 months | Captopril was associated with 7% reduction in mortality at 5 weeks (P = 0.02). |
| GISSI-3 (1994, 1996) Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico, 1994; 1996 | AMI | 19 394 | Lisinopril (10 mg daily) versus placebo | 6 weeks, 6 months | Lisinopril started within 24 h of AMI was associated with 12 and 6% reduction in mortality at 6 weeks and 6 months, respectively (P = 0.03) |
| CONSENSUS II (1992) Swedberg et al., 1992 | AMI | 6090 | Enalapril (intravenous enalaprilat 1 mg followed by enalapril 20 mg daily) versus placebo | 6 months | Enalapril started within 24 h of AMI did not improve survival at 6 months |
| SAVE (1994) Rutherford et al., 1994 | AMI and LVEF ≤ 40% | 2231 | Captopril (12.5–50 mg thrice daily) versus placebo | 42 months | Captopril was associated with 32% reduction in mortality (P = 0.029). |
| TRACE (1995, 1999, 2005) Kober et al., 1995; Torp-Pedersen and Kober, 1995; Buch et al., 2005 | AMI and LVEF ≤ 35% | 1749 | Tradolapril (4 mg daily) versus placebo | Up to 10–12 years | Tradolapril was associated with 25–30% reductions in mortality, sudden death and heart failure progression at 2–4 year follow-up (all P < 0.05) |
| AIRE (1993, 1997) The AIRE Study Investigators, 1993; Cleland et al., 1997 | AMI with heart failure | 2006 | Ramipril (5 mg twice daily) versus placebo | 15 months | Ramipril reduced risk of sudden cardiac death (P = 0.011) and heart failure progression by 30 and 23%, respectively (P = 0.017) |
| SMILE (1995) Ambrosioni et al., 1995 | AMI | 1556 | Zofenopril (15 mg daily) | 1 year | Zofenopril reduced mortality or heart failure by 34% (P = 0.018) and 29% (P = 0.011) at 6 weeks and 1 year, respectively |
| ARB | |||||
| VALIANT (2003) Pfeffer et al., 2003 | AMI and heart failure | 14 793 | Valsartan (20–160 mg twice daily) versus captopril (6.25–50 mg thrice daily) versus both (valsartan 20–80 mg twice daily + captopril 6.25–50 mg thrice daily) | 24.7 months | Valsartan was as effective as captopril. Combination therapy caused more adverse events without improvement in survival |
| OPTIMAAL (2002) Dickstein et al., 2002 | AMI with heart failure | 5477 | Losartan (50 mg daily) versus captopril (50 mg thrice daily) | 2.7 years | Losartan was better tolerated than captopril despite having similar efficacy |