Angiotensin-converting-enzyme inhibition in stable coronary artery disease.
Angiotensin-converting-enzyme inhibition in stable coronary artery disease.
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DOI：
10.1056/nejmoa042739
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发表时间：
2004-11
期刊：
影响因子：
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通讯作者：
E. Braunwald;M. Domanski;S. Fowler;N. Geller;B. Gersh;J. Hsia;M. Pfeffer;M. Rice;Y. Rosenberg;J. Rouleau
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文献类型：
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作者：
E. Braunwald;M. Domanski;S. Fowler;N. Geller;B. Gersh;J. Hsia;M. Pfeffer;M. Rice;Y. Rosenberg;J. Rouleau
血管紧张素转换酶（ACE）抑制剂可有效降低左心室收缩功能障碍或心力衰竭患者的心力衰竭、心肌梗死和心血管原因死亡的风险。ACE抑制剂也被证明可以减少患有血管疾病但没有心力衰竭的患者的动脉粥样硬化并发症。方法：在血管紧张素转换酶抑制剂（PEACE）预防事件试验中，我们检验了一个假设，即稳定性冠状动脉疾病和左心室功能正常或轻度降低的患者从现代常规治疗中加入ACE抑制剂获得治疗获益。该试验是一项双盲、安慰剂对照研究，其中8290名患者被随机分配接受群多普利，目标剂量为每天4 mg（4158名患者）或匹配的安慰剂（4132名患者）。结果患者的平均（+/-SD）年龄为64 ± 8岁，平均血压为133 ± 17/78 ± 10 mm Hg，平均左心室射血分数为58 ± 9%。这些患者接受了强化治疗，其中72%的患者以前接受过冠状动脉血运重建，70%的患者接受过降脂药物治疗。主要终点的发生率--心血管原因、心肌梗死或冠状动脉血运重建导致的死亡--在群多普利组为21.9%，而安慰剂组为22.5（群多普利组的风险比为0.96; 95%置信区间为0.88 ~ 1.06; P=0.43），中位随访期为4.8年。结论：在稳定型冠心病和左心室功能保留的患者中，接受“当前标准”治疗，心血管事件发生率低于既往血管疾病患者ACE抑制剂试验，没有证据表明加入ACE抑制剂在心血管原因死亡、心肌梗死或冠状动脉血运重建方面提供进一步的益处。
BACKGROUND Angiotensin-converting-enzyme (ACE) inhibitors are effective in reducing the risk of heart failure, myocardial infarction, and death from cardiovascular causes in patients with left ventricular systolic dysfunction or heart failure. ACE inhibitors have also been shown to reduce atherosclerotic complications in patients who have vascular disease without heart failure. METHODS In the Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial, we tested the hypothesis that patients with stable coronary artery disease and normal or slightly reduced left ventricular function derive therapeutic benefit from the addition of ACE inhibitors to modern conventional therapy. The trial was a double-blind, placebo-controlled study in which 8290 patients were randomly assigned to receive either trandolapril at a target dose of 4 mg per day (4158 patients) or matching placebo (4132 patients). RESULTS The mean (+/-SD) age of the patients was 64+/-8 years, the mean blood pressure 133+/-17/78+/-10 mm Hg, and the mean left ventricular ejection fraction 58+/-9 percent. The patients received intensive treatment, with 72 percent having previously undergone coronary revascularization and 70 percent receiving lipid-lowering drugs. The incidence of the primary end point--death from cardiovascular causes, myocardial infarction, or coronary revascularization--was 21.9 percent in the trandolapril group, as compared with 22.5 percent in the placebo group (hazard ratio in the trandolapril group, 0.96; 95 percent confidence interval, 0.88 to 1.06; P=0.43) over a median follow-up period of 4.8 years. CONCLUSIONS In patients with stable coronary heart disease and preserved left ventricular function who are receiving "current standard" therapy and in whom the rate of cardiovascular events is lower than in previous trials of ACE inhibitors in patients with vascular disease, there is no evidence that the addition of an ACE inhibitor provides further benefit in terms of death from cardiovascular causes, myocardial infarction, or coronary revascularization.