title: Mortality rates in elderly patients who take different angiotensin-converting enzyme inhibitors after acute myocardial infarction: a class effect?
abstract: BACKGROUND
  Several randomized, controlled trials show that angiotensin-converting enzyme (ACE) inhibitors improve survival in patients who have had an acute myocardial infarction. However, existing data from trials do not address whether all ACE inhibitors benefit patients similarly.
  
  
  OBJECTIVE
  To evaluate whether all ACE inhibitors are associated with similar mortality in patients 65 years of age or older who have had an acute myocardial infarction.
  
  
  METHODS
  Retrospective cohort study that used linked hospital discharge and prescription databases containing information on 18 453 patients 65 years of age or older who were admitted for an acute myocardial infarction between 1 April 1996 and 31 March 2000.
  
  
  METHODS
  109 hospitals in Quebec, Canada.
  
  
  METHODS
  7512 patients who filled a prescription for an ACE inhibitor within 30 days of discharge and who continued to receive the same drug for at least 1 year.
  
  
  METHODS
  The association between the specific drugs and clinical outcomes was measured by using Cox proportional hazards models, with adjustment for demographic, clinical, physician, and hospital variables and dosage categories, represented by time-dependent variables.
  
  
  RESULTS
  Enalapril, fosinopril, captopril, quinapril, and lisinopril were associated with higher mortality than was ramipril; the adjusted hazard ratios and 95% CIs were 1.47 (95% CI, 1.14 to 1.89), 1.71 (CI, 1.29 to 2.25), 1.56 (CI, 1.13 to 2.15), 1.58 (CI, 1.10 to 2.82), and 1.28 (CI, 0.98 to 1.67), respectively. The adjusted hazard ratio associated with perindopril was 0.98 (CI, 0.60 to 1.60).
  
  
  CONCLUSIONS
  The administrative databases did not contain detailed clinical information, and unmeasured factors associated with a patient's risk for death may have influenced physicians' prescription choices.
  
  
  CONCLUSIONS
  Survival benefits in the first year after acute myocardial infarction in patients 65 years of age or older seem to differ according to the specific ACE inhibitor prescribed. Ramipril was associated with lower mortality than most other ACE inhibitors.
authors.affiliation: The Montreal General Hospital, Jewish General Hospital, and McGill University, Montreal, Quebec, Canada. louise.pilote@mcgill.ca
authors.forename: Louise
authors.initials: L
authors.lastname: Pilote
authors.forename: Michal
authors.initials: M
authors.lastname: Abrahamowicz
authors.forename: Eric
authors.initials: E
authors.lastname: Rodrigues
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Eisenberg
authors.forename: Elham
authors.initials: E
authors.lastname: Rahme
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use*; D019992:Databases as Topic; D005260:Female; D006801:Humans; D008297:Male; D015394:Molecular Structure; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D010351:Patient Discharge; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055502:Secondary Prevention
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors