title: Effects of the early ACE inhibition in diabetic nonthrombolyzed patients with anterior acute myocardial infarction.
abstract: OBJECTIVE
  The aim of the present study was to evaluate the clinical efficacy of the ACE inhibitor zofenopril in a cohort of diabetic patients with nonthrombolyzed anterior acute myocardial infarction who were enrolled in the Survival of Myocardial Infarction Long-Term Evaluation (SMILE) trial.
  
  
  METHODS
  Among the overall population of 1,512 patients, 303 (20.0%) had diabetes. The primary end point of this study was the effect of treatment on the 6-week combined occurrence of death and severe congestive heart failure (CHF). Secondary end points included the evaluation of the 6-week rate of major cardiovascular events as well as the 1-year survival rate.
  
  
  RESULTS
  After 6 weeks of double-blind treatment, zofenopril significantly reduced both the incidence of the primary end point (8.6 vs. 18.3%; P = 0.019) and the 6-week incidence of severe CHF (0 vs. 7.3%; P = 0.001) in diabetic patients, and the effect was greater than that observed in nondiabetic patients. Conversely, 1-year mortality was significantly reduced among nondiabetic patients (9.1 vs. 13.8%; P = 0.010), whereas in the diabetic population, the decrease did not reach statistical significance (13.7 vs. 16.5%; P = 0.52).
  
  
  CONCLUSIONS
  The present data suggest that the clinical outcome of patients with diabetes and myocardial infarction can be significantly improved by early treatment with zofenopril. The lesser effect on 1-year mortality seems to suggest that long-term treatment is probably needed to maintain the benefits of the early ACE inhibition in patients with diabetes.
authors.affiliation: Department of Internal Medicine, University of Bologna, Bologna, Italy. claudio@med.unibo.it
authors.forename: Claudio
authors.initials: C
authors.lastname: Borghi
authors.forename: Stefano
authors.initials: S
authors.lastname: Bacchelli
authors.forename: Daniela Degli
authors.initials: DD
authors.lastname: Esposti
authors.forename: Ettore
authors.initials: E
authors.lastname: Ambrosioni
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002216:Captopril / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D003402:Creatine Kinase / Q000097:blood; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D012307:Risk Factors; D012907:Smoking; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; C044958:zofenopril; D002216:Captopril; D003402:Creatine Kinase