Clinical effects of early angiotensin-converting enzyme inhibitor treatment for acute myocardial infarction are similar in the presence and absence of aspirin - Systematic overview of individual data from 96,712 randomized patients
Clinical effects of early angiotensin-converting enzyme inhibitor treatment for acute myocardial infarction are similar in the presence and absence of aspirin - Systematic overview of individual data from 96,712 randomized patients
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DOI：
10.1016/s0735-1097(00)00638-0
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发表时间：
2000-06-01
影响因子：
24
通讯作者：
Yusuf, S
中科院分区：
文献类型：
--
作者：
Latini, R;Tognoni, G;Yusuf, S
我们试图确定早期血管紧张素转换酶（ACE）抑制剂（ACEi）治疗急性心肌梗死（MI）的临床效果是否受到同时使用阿司匹林（阿萨）的影响。阿司匹林抑制血管扩张性肾上腺素的合成，原则上，这种抑制作用可能拮抗ACEi的某些作用。但它是不确定的，在实践中，这是否会影响ACEi对死亡率和主要发病率后MI.METHODS的影响，这篇综述寻求个体患者的数据，从所有试验涉及1,000多名患者随机分配到接受ACEi或控制开始在急性期MI（0-36小时发病），并持续4至6周。在4项合格试验中，98，496例患者中有96，712例患者的阿萨合并用药数据可用结果：ACEi组和对照组的30天死亡率分别为7.1%和7.6%，分别为7.1%和7.6%。（标准差[SD]，2%）成比例降低（95%置信区间2%至11%，p = 0.004）。血管紧张素转换酶抑制剂与86,484例服用阿萨的患者（降低6% [SD，3%]）和10,228例未服用ASA的患者（降低10% [SD，5%]：这些降低之间的异质性卡方检验= 0.4; p = 0.5）的30天死亡率降低比例相似。血管紧张素转换酶抑制剂导致持续性低血压（17.9% ACEi vs. 9.4%对照）和肾功能不全（1.3% ACEi vs. 0.6%对照）的发生率明显增加，但没有充分证据表明这些效应在存在或不存在阿萨时存在差异（异质性卡方分别= 0.4和0.0;均不显著）。也没有很好的证据表明，ACEi对其他临床结果的影响改变了伴随阿萨use.CONCLUSIONS阿萨和ACEi是有益的急性心肌梗死。目前的结果支持在急性心肌梗死早期使用ACEi，无论是否给予阿萨。（美国科尔心脏病学杂志2000;35：1801-7）（C）2000年美国心脏病学会。
OBJECTIVES We sought to determine whether the clinical effects of early angiotensin-converting enzyme (ACE) inhibitor (ACEi) treatment for acute myocardial infarction (MI) are influenced by the concomitant use of aspirin (ASA).BACKGROUND Aspirin and ACEi both reduce mortality when given early after MI. Aspirin inhibits the synthesis of vasodilating prostaglandins, and, in principle, this inhibition might antagonize some of the effects of ACEi. But it is uncertain whether, in practice, this influences the effects of ACEi on mortality and major morbidity after MI.METHODS This overview sought individual patient data from all trials involving more than 1,000 patients randomly allocated to receive ACEi or control starting in the acute phase of MI (0-36 h from onset) and continuing for four to six weeks. Data on concomitant ASA use were available for 96,712 of 98,496 patients in four eligible trials (and for none of 1,556 patients in the one other eligible trial).RESULTS Overall 30-day mortality was 7.1% among patients allocated to ACEi and 7.6% among those allocated to control, corresponding to a 7% (standard deviation [SD], 2%) proportional reduction (95% confidence interval 2% to 11%, p = 0.004). Angiotensin-converting enzyme inhibitor was associated with similar proportional reductions in 30-day mortality among the 86,484 patients who were taking ASA (6% [SD, 3%] reduction) and among the 10,228 patients who were not (10% [SD, 5%] reduction: chi-squared test of heterogeneity between these reductions = 0.4; p = 0.5). Angiotensin-converting enzyme inhibitor produced definite increases in the incidence of persistent hypotension (17.9% ACEi vs. 9.4% control) and of renal dysfunction (1.3% ACEi vs. 0.6% control), but there was no good evidence that these effects were different in the presence or absence of ASA (chi-squared for heterogeneity = 0.4 and 0.0, respectively; both not significant). Nor was there good evidence that the effects of ACEi on other clinical outcomes were changed by concomitant ASA use.CONCLUSIONS Both ASA and ACEi are beneficial in acute MI. The present results support the early use of ACEi in acute MI, irrespective of whether or not ASA is being given. (J Am Coll Cardiol 2000;35:1801-7) (C) 2000 by the American College of Cardiology.