Efficacy of perindopril in reducing risk of cardiac events in patients with revascularized coronary artery disease.
BACKGROUND
The aim of the study was to assess the effect on cardiac events of adding perindopril 8 mg once daily to standard preventive therapy in the subgroup of EUROPA patients with previous revascularization and without previous myocardial infarction (MI).


METHODS
We conducted a subgroup analysis of the EUROPA study patients according to their revascularization and previous MI history. Among the 12,218 patients of EUROPA, we identified 6709 (54.9%) patients who had a previous revascularization. Approximately equal proportions had undergone percutaneous coronary intervention (3122) or coronary artery bypass grafting (3136). Of the revascularized patients, 3047 (24.9%) patients had not experienced a previous MI.


RESULTS
Out of the 6709 revascularized patients, 3340 were treated with perindopril and 3369 with placebo. Baseline characteristics were similar to the whole EUROPA population in terms of demographics, medical history, physical examination (heart rate, blood pressure), and medications at screening. The mean patient age was 60 years, and 85% were men. The relative risk reduction with perindopril 8 mg was 17.3% (95% CI 1.3%-30.8%, P = .035) for the composite primary end point of cardiovascular death, nonfatal MI, and resuscitated cardiac arrest and was 23% (95% CI 4.9%-37.6%, P = .015) for fatal and nonfatal MI. In the 3047 revascularized patients without a history of MI, perindopril was associated with a relative risk reduction of 31.7% for fatal and nonfatal MI (95% CI 4.4%-51.2%, P = .026).


CONCLUSIONS
Perindopril 8 mg daily is beneficial for primary and secondary prevention of cardiac events in patients with coronary artery disease without clinical evidence of heart failure including those with previous revascularization.
Fox
Kim M
KM
Cardiology Department, Royal Brompton Hospital, Sydney Street, London, UK. k.fox@rbh.nthames.nhs.uk
Bertrand
Michel E
ME
Remme
Willem J
WJ
Ferrari
Roberto
R
Simoons
Maarten L
ML
Deckers
Jaap W
JW
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000150:complications* / Q000601:surgery; D005260:Female; D006331:Heart Diseases / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D020913:Perindopril / Q000627:therapeutic use*; D012307:Risk Factors
D000806:Angiotensin-Converting Enzyme Inhibitors; D020913:Perindopril