EFFECT OF CAPTOPRIL ON MORTALITY AND MORBIDITY IN PATIENTS WITH LEFT-VENTRICULAR DYSFUNCTION AFTER MYOCARDIAL-INFARCTION - RESULTS OF THE SURVIVAL AND VENTRICULAR ENLARGEMENT TRIAL
EFFECT OF CAPTOPRIL ON MORTALITY AND MORBIDITY IN PATIENTS WITH LEFT-VENTRICULAR DYSFUNCTION AFTER MYOCARDIAL-INFARCTION - RESULTS OF THE SURVIVAL AND VENTRICULAR ENLARGEMENT TRIAL
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DOI：
10.1056/nejm199209033271001
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发表时间：
1992-09-03
影响因子：
158.5
通讯作者：
HAWKINS, CM
中科院分区：
文献类型：
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作者：
PFEFFER, MA;BRAUNWALD, E;HAWKINS, CM
背景心肌梗死后左心室扩张和功能障碍是死亡的主要预测因素。在实验和临床研究中，血管紧张素转换酶抑制剂卡托普利的长期治疗减弱了心室扩张和重塑。我们研究了卡托普利是否能降低心肌梗死后左心室功能不全患者的发病率和死亡率。在心肌梗死后3 - 16天内，2231例射血分数≤ 40%但无明显心力衰竭或心肌缺血症状的患者被随机分配接受安慰剂（1116例）或卡托普利（1115例）双盲治疗，平均随访42个月。与安慰剂组（275例死亡，或25%）相比，卡托普利组（228例死亡，或20%）的全因死亡率显著降低;风险降低19%（95%置信区间，3%至32%; P = 0.019）。此外，在卡托普利组中，致死性和非致死性主要心血管事件的发生率持续降低。心血管原因死亡的风险降低了21%（95%置信区间，5 - 35%; P = 0.014），心血管原因死亡的风险降低了37%（95%置信区间，20 - 50%; P = 0.014），
Background. Left ventricular dilatation and dysfunction after myocardial infarction are major predictors of death. In experimental and clinical studies, long-term therapy with the angiotensin-converting-enzyme inhibitor captopril attenuated ventricular dilatation and remodeling. We investigated whether captopril could reduce morbidity and mortality in patients with left ventricular dysfunction after a myocardial infarction.Methods. Within 3 to 16 days after myocardial infarction, 2231 patients with ejection fractions of 40 percent or less but without overt heart failure or symptoms of myocardial ischemia were randomly assigned to receive double-blind treatment with either placebo (1116 patients) or captopril (1115 patients) and were followed for an average of 42 months.Results. Mortality from all causes was significantly reduced in the captopril group (228 deaths, or 20 percent) as compared with the placebo group (275 deaths, or 25 percent); the reduction in risk was 19 percent (95 percent confidence interval, 3 to 32 percent; P = 0.019). In addition, the incidence of both fatal and nonfatal major cardiovascular events was consistently reduced in the captopril group. The reduction in risk was 21 percent (95 percent confidence interval, 5 to 35 percent; P = 0.014) for death from cardiovascular causes, 37 percent (95 percent confidence interval, 20 to 50 percent; P