title: Causes of death in patients with acute myocardial infarction treated with angiotensin-converting enzyme inhibitors: findings from the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto (GISSI)-3 trial.
abstract: BACKGROUND
  The causes of death occurring in clinical trials of myocardial infarction (MI) are scarcely reported in the literature. The present analysis is aimed to describe the inhospital causes of death in patients with acute MI stratified to angiotensin converting enzyme (ACE) inhibitor treatment/no treatment, as described in the GISSI-3 trial. Furthermore, the 5-year survival analysis of GISSI-3 patients is reported.
  
  
  RESULTS
  An independent committee assigned the definition of causes of death of GISSI-3 based on clinical and/or anatomical data. Univariate and multivariable analyses were performed to identify the predictors of early and late deaths. Kaplan-Meier mortality curves were used to describe the effects of ACE-I treatment on mortality on a median follow-up period of 56 months. Patients receiving lisinopril had fewer inhospital cardiac deaths than patients allocated to the no-lisinopril group (4.7% vs 5.3%, P = .052), corresponding to a 12% relative risk reduction. The risk of dying from cardiac rupture was reduced by 39% by lisinopril treatment. The improvement in survival associated with the lisinopril treatment was mainly due to a reduction in cardiac rupture, electromechanical dissociation, and pump failure occurring early (within 4 days) from the onset of MI symptoms. The beneficial effects of lisinopril observed at 6 weeks (8 fewer deaths per 1000 treated patients) were maintained up to nearly 5 years (10 fewer deaths per 1000).
  
  
  CONCLUSIONS
  Early administration of ACE inhibitors in unselected patients with acute MI should be considered standard therapy to reduce early deaths, specifically those due to cardiac rupture. The early beneficial effect persisted up to nearly 5 years.
authors.affiliation: Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pedrazzini
authors.forename: Eugenio
authors.initials: E
authors.lastname: Santoro
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
authors.forename: Laurie
authors.initials: L
authors.lastname: Fromm
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Franzosi
authors.forename: Tiziano
authors.initials: T
authors.lastname: Mocetti
authors.forename: Lidia
authors.initials: L
authors.lastname: Staszewsky
authors.forename: Simona
authors.initials: S
authors.lastname: Barlera
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D017706:Lisinopril / Q000627:therapeutic use*; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D017706:Lisinopril