title: Zofenopril and ramipril in patients with left ventricular systolic dysfunction after acute myocardial infarction: A propensity analysis of the Survival of Myocardial Infarction Long-term Evaluation (SMILE) 4 study.
abstract: BACKGROUND
  This was a propensity score analysis of the prospective, randomized, double-blind Survival of Myocardial Infarction Long-term Evaluation (SMILE) 4 study in which one-year treatment with zofenopril 60 mg plus acetylsalicylic acid (ASA) 100 mg gave superior results compared to ramipril 10 mg plus ASA in terms of death or hospitalization for cardiovascular causes in patients with acute myocardial infarction (AMI) complicated by left ventricular dysfunction (LVD).
  
  
  METHODS
  A total of 716 patients of the intention-to-treat population were divided into homogeneous propensity quintiles (Q) using a logistic regression model (QI: best risk profile; QV: worst risk profile).
  
  
  RESULTS
  Treatment was associated with a similar low rate of major cardiovascular events in any Q. However, the efficacy of zofenopril was better than that of ramipril in QII, QV, and particularly QIII (odds ratio (OR) and 95% confidence interval: 0.43 (0.21-0.87), p<0.05]. This result was primarily attributed to a decrease in the risk of cardiovascular hospitalization, particularly striking in the QIII (OR: 0.40, 0.19-0.85; p<0.05). Mortality rate did not significantly differ between the two treatments in any Q.
  
  
  CONCLUSIONS
  In the SMILE-4 study the propensity analysis confirmed the efficacy of zofenopril in the prevention of long-term cardiovascular outcomes irrespective of the cardiovascular risk profile of post-AMI patients.
authors.affiliation: Unit of Internal Medicine, University of Bologna, Italy claudio.borghi@unibo.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Borghi
authors.affiliation: Clinical Research Unit, Italian Institute of Telemedicine, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Omboni
authors.affiliation: Division of Cardiology, University of Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Novo
authors.affiliation: Cardiology, University and Emergency Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
authors.forename: Dragos
authors.initials: D
authors.lastname: Vinereanu
authors.affiliation: Division of Cardiology, University of Perugia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ambrosio
authors.affiliation: Unit of Internal Medicine, University of Bologna, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Ambrosioni
mesh_terms: D002216:Captopril / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003710:Demography; D004359:Drug Therapy, Combination; D023381:Endpoint Determination; D005260:Female; D006760:Hospitalization; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D057216:Propensity Score; D017257:Ramipril / Q000627:therapeutic use*; D016019:Survival Analysis; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: C044958:zofenopril; D002216:Captopril; D017257:Ramipril
keywords: Acute myocardial infarction; acetylsalicylic acid; angiotensin-converting enzyme inhibitors; left ventricular dysfunction; propensity analysis