Impact of ramipril versus other angiotensin-converting enzyme inhibitors on outcome of unselected patients with ST-elevation acute myocardial infarction.
We examined the impact of treatment with ramipril versus other angiotensin-converting enzyme (ACE) inhibitors on clinical outcome in unselected patients of the prospective multicenter registry Maximal Individual Therapy of Acute Myocardial Infarction PLUS registry (MITRA PLUS). Of 14,608 consecutive patients with ST-elevation acute myocardial infarction, 4.7% received acute therapy with ramipril, 39.0% received other ACE inhibitor therapy, and 56.3% received no ACE inhibitor therapy. In a multivariate analysis, the treatment with ramipril compared with the treatment without ACE inhibitors was associated with a significantly lower hospital mortality and a lower rate of nonfatal major adverse coronary and cerebrovascular events. Compared with other generic ACE inhibitors, ramipril therapy was independently associated with a significantly lower hospital mortality (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.32 to 0.90) and a lower rate of nonfatal major adverse coronary and cerebrovascular events (OR 0.65, 95% CI 0.46 to 0.93), but not with a lower rate of heart failure at discharge (OR 0.79, 95% CI 0.50 to 1.27).
Wienbergen
Harm
H
Herzzentrum Ludwigshafen, Medizinische Klinik B, Bremserstrasse 79, D-67063 Ludwigshafen, Germany. HarmWnbrgn@aol.com
Schiele
Rudolf
R
Gitt
Anselm Kai
AK
Juenger
Claus
C
Heer
Tobias
T
Meisenzahl
Christina
C
Landgraf
Helmut
H
Bossaller
Claus
C
Senges
Jochen
J
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D017257:Ramipril / Q000008:administration & dosage / Q000627:therapeutic use*; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis
D000806:Angiotensin-Converting Enzyme Inhibitors; D017257:Ramipril