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冠心病且无心力衰竭或左心室收缩功能障碍患者使用血管紧张素转换酶抑制剂：长期随机对照试验综述

Angiotensin-converting enzyme inhibitors in patients with coronary artery disease and absence of heart failure or left ventricular systolic dysfunction: an overview of long-term randomized controlled trials.

作者信息

Danchin Nicolas, Cucherat Michel, Thuillez Christian, Durand Eric, Kadri Zena, Steg Philippe G

机构信息

Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.

出版信息

Arch Intern Med. 2006 Apr 10;166(7):787-96. doi: 10.1001/archinte.166.7.787.

DOI:10.1001/archinte.166.7.787

PMID:16606817

Abstract

BACKGROUND

Results of randomized trials of angiotensin-converting enzyme inhibitors in patients with coronary artery disease (CAD) and preserved left ventricular function are conflicting. We undertook this study to determine whether long-term prescription of angiotensin-converting enzyme inhibitors decreases major cardiovascular events and mortality in patients who have CAD and no evidence of left ventricular systolic dysfunction.

METHODS

We searched MEDLINE, EMBASE, and IPA databases, the Cochrane Controlled Trials Register (1990-2004), and reports from scientific meetings (2003-2004), and we reviewed secondary sources. Search terms included angiotensin-converting enzyme inhibitors, coronary artery disease, randomi(s)zed controlled trials, clinical trials, and myocardial infarction. Eligible studies included randomized controlled trials in patients who had CAD and no heart failure or left ventricular dysfunction, with follow-up omicronf 2 years or longer. Of 1146 publications screened, 7 met our selection criteria and included a total of 33 960 patients followed up for a mean of 4.4 years.

RESULTS

Five trials included only patients with documented CAD. One trial included patients with documented CAD (80%) or patients who had diabetes mellitus and 1 or more additional risk factors, and another trial included patients who had CAD, a history of transient ischemic attack, or intermittent claudication. Treatment with angiotensin-converting enzyme inhibitors decreased overall mortality (odds ratio, 0.86; 95% confidence interval, 0.79-0.93), cardiovascular mortality (odds ratio, 0.81; 95% confidence interval, 0.73-0.90), myocardial infarction (odds ratio, 0.82; 95% confidence interval, 0.75-0.89), and stroke (odds ratio, 0.77; 95% confidence interval, 0.66-0.88). Other end points, including resuscitation after cardiac arrest, myocardial revascularization, and hospitalization because of heart failure, were also reduced.

CONCLUSION

Angiotensin-converting enzyme inhibitors reduce total mortality and major cardiovascular end points in patients who have CAD and no left ventricular systolic dysfunction or heart failure.

摘要

背景

血管紧张素转换酶抑制剂用于冠状动脉疾病（CAD）且左心室功能正常患者的随机试验结果相互矛盾。我们开展这项研究以确定血管紧张素转换酶抑制剂的长期处方是否能降低患有CAD且无左心室收缩功能障碍证据患者的主要心血管事件及死亡率。

方法

我们检索了MEDLINE、EMBASE和IPA数据库、Cochrane对照试验注册库（1990 - 2004年）以及科学会议报告（2003 - 2004年），并查阅了二手资料。检索词包括血管紧张素转换酶抑制剂、冠状动脉疾病、随机对照试验、临床试验和心肌梗死。符合条件的研究包括对患有CAD且无心力衰竭或左心室功能障碍患者的随机对照试验，随访时间为2年或更长。在筛选的1146篇出版物中，7篇符合我们的入选标准，共纳入33960例患者，平均随访4.4年。

结果

5项试验仅纳入有记录的CAD患者。1项试验纳入有记录的CAD患者（80%）或患有糖尿病且有1项或更多其他危险因素的患者，另一项试验纳入患有CAD、短暂性脑缺血发作史或间歇性跛行的患者。使用血管紧张素转换酶抑制剂治疗可降低总体死亡率（比值比，0.86；95%置信区间，0.79 - 0.93）、心血管死亡率（比值比，0.81；95%置信区间，0.73 - 0.90）、心肌梗死（比值比，0.82；95%置信区间，0.75 - 0.89）和中风（比值比，0.77；95%置信区间，0.66 - 0.88）。其他终点，包括心脏骤停后的复苏、心肌血运重建和因心力衰竭住院也有所减少。