Gustafsson I, Torp-Pedersen C, Køber L, Gustafsson F, Hildebrandt P
Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Denmark.
J Am Coll Cardiol. 1999 Jul;34(1):83-9. doi: 10.1016/s0735-1097(99)00146-1.
This study evaluated the efficacy of long-term treatment with the angiotensin-converting enzyme (ACE) inhibitor trandolapril in diabetic patients with left ventricular dysfunction after acute myocardial infarction (AMI).
Patients with diabetes mellitus have a high mortality following AMI, probably due to a high risk of congestive heart failure and reinfarction. Because ACE inhibition effectively reduces progression of heart failure, it could be particularly beneficial in diabetic patients after AMI.
The study is a retrospective analysis using data from the Trandolapril Cardiac Evaluation (TRACE) study, which was a randomized, double-blind, placebo-controlled trial of trandolapril in 1,749 patients with AMI and ejection fraction < or =35%. The mean follow-up time was 26 months.
A history of diabetes was found in 237 (14%) of the 1,749 patients. Treatment with trandolapril resulted in a relative risk (RR) of death from any cause for the diabetic group of 0.64 (95% confidence interval 0.45 to 0.91) versus 0.82 (0.69 to 0.97) for the nondiabetic group. In the diabetic group, trandolapril reduced the risk of progression to severe heart failure markedly (RR, 0.38 [0.21 to 0.67]), and no significant reduction of this end point was found in the nondiabetic group.
The ACE inhibition after myocardial infarction complicated by left ventricular dysfunction appears to be of considerable importance in patients with diabetes mellitus by saving lives and substantially reducing the risk of progression to severe heart failure.
本研究评估血管紧张素转换酶（ACE）抑制剂群多普利长期治疗对急性心肌梗死（AMI）后左心室功能不全的糖尿病患者的疗效。
糖尿病患者急性心肌梗死后死亡率很高，可能是由于充血性心力衰竭和再梗死风险高。由于ACE抑制可有效降低心力衰竭进展，对急性心肌梗死后的糖尿病患者可能特别有益。
本研究是一项回顾性分析，使用了群多普利心脏评估（TRACE）研究的数据，该研究是一项群多普利治疗1749例急性心肌梗死且射血分数≤35%患者的随机、双盲、安慰剂对照试验。平均随访时间为26个月。
1749例患者中有237例（14%）有糖尿病病史。群多普利治疗使糖尿病组任何原因导致的死亡相对风险（RR）为0.64（95%置信区间0.45至0.91），而非糖尿病组为0.82（0.69至0.97）。在糖尿病组中，群多普利显著降低了进展为严重心力衰竭的风险（RR，0.38[0.21至0.67]），而非糖尿病组未发现该终点有显著降低。
心肌梗死后并发左心室功能不全时，ACE抑制对糖尿病患者似乎相当重要，可挽救生命并大幅降低进展为严重心力衰竭的风险。
