European Heart Journal Advance Access originally published online on December 8, 2004
European Heart Journal 2005 26(2):145-152; doi:10.1093/eurheartj/ehi021
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European Heart Journal vol. 26 no. 2 © The European Society of Cardiology 2004; all rights reserved.
The long-term impact of the angiotensin-converting enzyme inhibitor trandolapril on mortality and hospital admissions in patients with left ventricular dysfunction after a myocardial infarction: follow-up to 12 years
1Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, Building 40, DK-2400 Copenhagen NV, Denmark
2National Institute of Public Health, Copenhagen, Denmark
3Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
4Medicon, Allerod, Denmark
Received 14 September 2004; revised 14 September 2004; accepted 23 September 2004; online publish-ahead-of-print 8 December 2004.
* Corresponding author. Fax: +45 39751803. E-mail address: pb{at}heart.dk
Aims To investigate the long-term benefits of treatment with angiotensin-converting enzyme (ACE)-inhibitors in patients with myocardial infarction (MI) and left ventricular dysfunction (LVD).
Methods and results In the trandolapril cardiac evaluation (TRACE) study, 1749 patients with LVD (ejection fraction
35%) were randomized to trandolapril (n=876) or placebo (n=873) 3–7 days post-MI. Enrolment lasted from 1990 to 1994; on-treatment follow-up ranged from 2 to 4 years. At study closure, all patients were recommended continued ACE-inhibitor use. National registries were used to track deaths and hospitalizations until 2002. Mortality was analysed with Cox proportional hazard models and hospitalization with Poisson regression models (models adjusted for observation time). Over 10–12 years of follow-up, a total of 1283 deaths and 9220 hospitalizations were registered. Compared with the placebo group, the trandolapril group had a significantly reduced risk of all-cause mortality (relative risk 0.89, 95% CI 0.80–0.99, P=0.03), all-cause hospitalizations (rate ratio 0.92, 95% CI 0.88–0.96, P<0.001), and cardiovascular hospitalizations (rate ratio 0.95, 95% CI 0.91–1.00, P=0.047), including congestive heart failure hospitalizations (rate ratio 0.85, 95% CI 0.77–0.93, P<0.001).
Conclusion In patients with LVD, use of trandolapril shortly after an MI for 2–4 years has long-term benefits. The beneficial effect on mortality and hospitalization rates is maintained for at least 10–12 years.
Key Words: ACE-inhibitors • Myocardial infarction • Mortality • Morbidity • Follow-up • Prognosis
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