Persistent reduction of mortality for five years after one year of acebutolol treatment initiated during acute myocardial infarction. The APSI Investigators. Acebutolol et Prévention Secondaire de l'Infarctus.
The APSI trial was a randomized placebo-controlled trial designed to assess the efficacy of 1 year of treatment by acebutolol in high-risk patients who had survived an acute myocardial infarction. At 1 year there was a statistically significant 48% relative reduction in total mortality (p = 0.019) in favor of acebutolol. In 1995 a long-term mortality survey was undertaken through an administrative inquiry and contacts with investigators. The vital status of 586 of the 607 (96.5%) patients enrolled was known at the cutoff date and all these patients were followed up for at least 5 years. During follow-up (in-trial and post-trial period), 74 deaths (24.8%) occurred in the acebutolol group and 96 (31.1%) in the placebo group (p = 0.10). No difference between the 2 groups was observed for the number of deaths that occurred after the end of the trial: 55 deaths (19.6%) among the 281 survivors in the acebutolol group and 59 deaths (21.7%) (p = 0.70) among the 272 survivors in the placebo group. The annual hazard rate (annual death rate), calculated year by year using the actuarial method, was significantly different (p < 0.01) only for the first year and was not significantly different thereafter. Thus, the initial benefit obtained in 1 year of treatment by acebutolol lasts for 5 years.
Cucherat
M
M
APSI Coordinating Center, Hopital cardiologique, Lyon France.
Boissel
J P
JP
Leizorovicz
A
A
D000070:Acebutolol / Q000627:therapeutic use*; D000206:Actuarial Analysis; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002423:Cause of Death; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality*; D010919:Placebos; D016016:Proportional Hazards Models; D012307:Risk Factors; D015996:Survival Rate
D000319:Adrenergic beta-Antagonists; D010919:Placebos; D000070:Acebutolol