title: Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. ACE-Inhibitor Myocardial Infarction Collaborative Group.
abstract: BACKGROUND
  We undertook a prospective systematic overview based on data from individual patients from five long-term randomised trials that assessed inhibitors of angiotensin-converting enzyme (ACE) in patients with left-ventricular dysfunction or heart failure.
  
  
  METHODS
  Three of the trials enrolled patients within a week after acute myocardial infarction. Data were combined by use of the Peto-Yusuf method.
  
  
  RESULTS
  Overall 12,763 patients were randomly assigned treatment or placebo and followed up for an average of 35 months. In the three post-infarction trials (n=5,966), mortality was lower with ACE inhibitors than with placebo (702/2995 [23.4%] vs 866/2971 [29.1%]; odds ratio 0.74 [95% CI 0.66-0-83]), as were the rates of readmission for heart failure (355 [11.9%] vs 460 [15.5%]; 0.73 [0.63-0.85]), reinfarction (324 [10.8%] vs 391 [13.2%]; 0.80 [0.69-0.94]), or the composite of these events (1049 [35.0%] vs 1244 [41.9%]; 0.75 [0.67-0.83]; all p<O.001). For all five trials the ACE inhibitor group had lower rates of death than the placebo group (1,467/6,391 [23.0%] vs 1,710/6,372 [26.8%]; 0.80 [0.74-0.87]) and lower rates of reinfarction (571 [8.9%] vs 703 [11.0%]; 0.79 [0.70-0.89]), readmission for heart failure (876 [13.7%] vs 1202 [18.9%]; 0.67 [0.61-0.74]), and the composite of these events (2161 [33.8%] vs 2610 [41.0%]; 0.72 [0.67-0.78]; all p<0.0001). The benefits were observed early after the start of therapy and persisted long term. The benefits of treatment on all outcomes were independent of age, sex, and baseline use of diuretics, aspirin, and beta-blockers. Although there was a trend towards greater reduction in risk of death or readmission for heart failure in patients with lower ejection fractions, benefit was apparent over the range examined.
authors.affiliation: Preventive Cardiology and Therapeutic Research Program, Hamilton Health Sciences Corporation Research Centre, McMaster University, Ontario, Canada.
authors.forename: M D
authors.initials: MD
authors.lastname: Flather
authors.forename: S
authors.initials: S
authors.lastname: Yusuf
authors.forename: L
authors.initials: L
authors.lastname: Køber
authors.forename: M
authors.initials: M
authors.lastname: Pfeffer
authors.forename: A
authors.initials: A
authors.lastname: Hall
authors.forename: G
authors.initials: G
authors.lastname: Murray
authors.forename: C
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: S
authors.initials: S
authors.lastname: Ball
authors.forename: J
authors.initials: J
authors.lastname: Pogue
authors.forename: L
authors.initials: L
authors.lastname: Moyé
authors.forename: E
authors.initials: E
authors.lastname: Braunwald
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors