Effects of the early ACE inhibition in diabetic nonthrombolyzed patients with anterior acute myocardial infarction.
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.
Borghi
Claudio
C
Department of Internal Medicine, University of Bologna, Bologna, Italy. claudio@med.unibo.it
Bacchelli
Stefano
S
Esposti
Daniela Degli
DD
Ambrosioni
Ettore
E
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
D000806:Angiotensin-Converting Enzyme Inhibitors; C044958:zofenopril; D002216:Captopril; D003402:Creatine Kinase