Long-term mortality in patients with myocardial infarction: impact of early treatment with captopril for 4 weeks.
OBJECTIVE
In an earlier interim report of the Chinese Cardiac Study (CCS-1) trial, 15,000 patients up to 36 hours after the onset of suspected acute myocardial infarction (AMI) were randomized to receive either oral captopril or matching placebo for one month. Results showed that captopril was associated with a non-significant reduction in 4-week mortality (681 [9.1%] captopril-allocated vs 730 [9.7%] placebo-allocated deaths; 2P = 0.19), but the long-term effects remained uncertain. The present study reports on the long-term effect of early captopril treatment on mortality and other major events in AMI patients of the earlier CCS-1 trial.


METHODS
Long-term follow-up was carried out in those hospitals which had recruited more than 20 cases in the CCS-1 trial. 8000 patients with MI were thus selected for long-term follow-up. Data on 6749 patients (84.4%) were available.


RESULTS
Patient characteristics were comparable between the treatment group (n = 3391) and the placebo group (n = 3358). Average follow-up time was 23.4 +/- 16.9 months; average age was 63.6 +/- 10.6 years, and 76.2% were male. At the end of the follow-up time, cardiac function of NYHA III-IV was 9.0% in the treatment group and 9.8% in the placebo group; the reinfarction rate was 5.6% vs. 6.0%; total cardiovascular events were 32.9% vs. 34.3%. Total mortality was 11.9% (n = 404) vs 13.8% (n = 463), with a 13.8% reduction in the captopril group (P = 0.03). Cardiovascular mortality was 10.0% vs. 11.8% (P = 0.01), death due to heart failure was 4.1% vs. 5.5% (P = 0.01). From the above results, it is estimated that early treatment with captopril can save 19 lives per 1000 patients treated; patients with systolic blood pressure (SBP) > or = 100 mm Hg at entry would have a long-term mortality 12.4% in the treatment group vs. 13.8% in the placebo group (P = 0.04) and patients with a heart rate (HR) > or = 60/minute at entry would have a long term mortality 12.0% in captopril groups vs. 14.5% in the placebo group (P = 0.01).


CONCLUSIONS
Early treatment with captopril during AMI for 4 weeks can significantly reduce long-term total mortality.
Liu
L
L
Fu Wai Hospital, Chinese Academy of Medical Sciences (CAMS), Beijing 100037, China.
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002216:Captopril / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000187:drug effects / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D002216:Captopril