Kjøller-Hansen L, Steffensen R, Grande P
The Heart Center, Rigshospitalet, Copenhagen, Denmark.
J Am Coll Cardiol. 2000 Mar 15;35(4):881-8. doi: 10.1016/s0735-1097(99)00634-8.
This study was performed to assess the effect of treatment with ramipril on the incidence of cardiac events after invasive revascularization in patients with asymptomatic moderate left ventricular dysfunction.
In patients with angina pectoris and left ventricular dysfunction, both invasive revascularization and treatment with angiotensin-converting enzyme inhibitors reduce cardiac mortality and morbidity. Whether there is a benefit from combining the two treatment strategies has never been evaluated prospectively.
After invasive revascularization, 159 patients with preoperative chronic stable angina pectoris, left ventricular ejection fraction between 0.30 and 0.50 and no clinical heart failure were randomly assigned to receive double-blind treatment with either ramipril or placebo and subsequently followed for a median of 33 months.
Ramipril reduced the incidence of the triple-composite end point of cardiac death, acute myocardial infarction or clinical heart failure (risk reduction 58%; 95% confidence interval 7% to 80%, p = 0.031). The incidence of the quadruple-composite end point of cardiac death, acute myocardial infarction, clinical heart failure or recurrent angina pectoris was not altered with ramipril. These findings were consistent across subgroups with respect to left ventricular ejection fraction below or above 0.40, and whether coronary artery bypass grafting or percutaneous transluminal coronary angioplasty was performed.
In patients with angina pectoris and asymptomatic moderate left ventricular dysfunction, long-term treatment with ramipril after invasive revascularization significantly reduced the incidence of the composite end point of cardiac death, acute myocardial infarction or clinical heart failure, indicating that the beneficial effects of angiotensin-converting enzyme inhibitor treatment may be extended to include treatment of this patient group.
本研究旨在评估雷米普利治疗对无症状性中度左心室功能不全患者进行有创血管重建术后心脏事件发生率的影响。
在心绞痛和左心室功能不全患者中，有创血管重建和血管紧张素转换酶抑制剂治疗均可降低心脏死亡率和发病率。两种治疗策略联合使用是否有益，此前从未进行过前瞻性评估。
在进行有创血管重建术后，将159例术前患有慢性稳定性心绞痛、左心室射血分数在0.30至0.50之间且无临床心力衰竭的患者随机分配，接受雷米普利或安慰剂的双盲治疗，随后进行中位时间为33个月的随访。
雷米普利降低了心脏死亡、急性心肌梗死或临床心力衰竭这一三联复合终点的发生率（风险降低58%；95%置信区间为7%至80%，p = 0.031）。雷米普利并未改变心脏死亡、急性心肌梗死、临床心力衰竭或复发性心绞痛这一四联复合终点的发生率。这些发现在左心室射血分数低于或高于0.40的亚组中，以及在进行冠状动脉旁路移植术或经皮冠状动脉腔内血管成形术的患者中均一致。
在心绞痛和无症状性中度左心室功能不全患者中，有创血管重建术后长期使用雷米普利治疗可显著降低心脏死亡、急性心肌梗死或临床心力衰竭这一复合终点的发生率，表明血管紧张素转换酶抑制剂治疗的有益作用可能扩展至包括对该患者群体的治疗。
