Pharmacological treatment during AMI and in secondary prevention: the scientific evidence

Table 10. ACE-inhibitors. Effect on mortality.
STUDIES DRUGS No. PATIENTS FOLLOW-UP VAR. P
During infarction
CONSENSUS II (1992) [91] ENALAPRIL 6,090 41-180 DAYS +11% 0.26
GISSI 3 (1996) [35] LISINOPRIL 19,394 42 DAYS -12% 0.03
ISIS 4 (1995) [47] CAPTOPRIL 58,050 35 DAYS -7% 0.02
ACE Inhibitor Coll. Group (1998) [1] ENALAPRIL, LISINOPRIL.CAPTOPRIL 98,496 30 DAYS -7% 0.004
After infarction
SAVE (1992) [71] CAPTOPRIL 2,231 42 MONTHS -19% 0.02
AIRE (1993) [2] RAMIPRIL 2,006 15 MONTHS -27% 0.002
TRACE (1995) [52] TRANDOLAPRIL 1,749 24-50 MONTHS -22% <0.001
 
META-ANALYSES No. STUDIES No. PATIENTS   VAR. P
During infarction
ISIS 4 (1995) [47] 15 100,963   -6% 0.006
After infarction & with l. v. dys.
ISIS 4 (1995) [47] 3 5,986   -22% <0.001

 

ACC/AHA GUIDELINES

The greatest benefit is found primarily in patients with an anterior infarction or with EF < 40%

  • Class I (1996):
    • Patients within the first 24 hours of a suspected AMI with ST-segment elevation in >2 anterior precordial leads or with clinical heart failure in the absence of significant hypotension or known contraindications to use of ACE inhibitors.
  • Class I (1999):
    • Patients within the first 24 hours of a suspected AMI with ST-segment elevation in >2 anterior precordial leads or with clinical heart failure in the absence of hypotension (systolic BP)
  • 1996:
    • Patients with MI and LV ejection fraction less than 40% or patients with clinical heart failure on the basis of systolic pump dysfunction during and after convalescence from AMI.
  • Class IIa:
    • All other patients within the first 24 hours of a suspected or established AMI, provided significant hypotension or other clear-cut contraindications are absent.
    • Asymptomatic patients with mildly impaired LV function (ejection fraction 40% to 50%) and a history of old MI.
  • Class IIb:
    • Patients who have recently recovered from MI but have normal or mildly abnormal global LV function.

ANMCO-SIC CLINICAL GUIDELINES

Type A evidence for patients with extensive AMI, EF < 45% or clinical or radiological signs of failure, in addition to patients with arterial hypertension