血管紧张素转换酶抑制剂对缺血性心肌病和中等射血分数患者临床结局的影响：PEACE试验的事后亚组分析
The effect of angiotensin-converting enzyme inhibitors on clinical outcomes in patients with ischemic cardiomyopathy and midrange ejection fraction: a post hoc subgroup analysis from the PEACE trial.
作者信息
Alzahrani Talal, Tiu John, Panjrath Gurusher, Solomon Allen
机构信息
Division of Cardiology, Department of Medicine, George Washington University, 2150 Pennsylvania Ave NW, Fourth Floor, Washington, DC, 20037, USA.
Division of Cardiology, Department of Medicine, George Washington University, Washington, DC, USA.
出版信息
Ther Adv Cardiovasc Dis. 2018 Dec;12(12):351-359. doi: 10.1177/1753944718809266. Epub 2018 Nov 15.
BACKGROUND
: There have been significant advances in the treatment of patients with cardiomyopathy with reduced ejection fraction (EF < 40%). However, there is a dearth of information in the treatment of patients with cardiomyopathy and midrange EF (40-50%). Current guidelines state to treat these patients similarly to patients with cardiomyopathy and preserved EF. Data from the Prevention of Events with Angiotensin-Converting Enzyme Inhibition (PEACE) trial were used to elucidate whether angiotensin-converting enzyme (ACE) inhibitors improve clinical outcomes in patients with ischemic cardiomyopathy and midrange EF.
METHODS
: A post hoc subgroup analysis of the PEACE trial was conducted to evaluate the effect of ACE inhibitors in a subgroup of patients with ischemic cardiomyopathy and midrange EF (40-50%). A Chi-square test and a Student's t-test were used to examine and compare the binary and continuous variables of baseline characteristics and outcomes between experimental and comparison groups.
RESULTS
: We studied a subgroup of patients from the PEACE trial with ischemic cardiomyopathy and midrange EF ( n = 2512 of 8290 total patients). Patients were assigned to either the interventional group ( n = 1247) or the placebo group ( n = 1265). There were no significant differences in baseline demographic and health characteristics between the two groups. During a total of 7 years (mean 4.7 years) of follow up, the risk of composite outcomes [all-cause mortality, nonfatal myocardial infarction, and stroke; relative risk (RR) 0.79, 95% confidence interval (CI) 0.63-0.98; p = 0.03] and all-cause mortality (RR 0.85, 95% CI 0.73-0.99; p = 0.03) was reduced in patients treated with trandolapril.
CONCLUSION
: This study revealed the benefit of ACE inhibitors among patients with ischemic cardiomyopathy and midrange EF.
背景
射血分数降低（EF<40%）的心肌病患者的治疗已取得显著进展。然而，关于射血分数中等（40-50%）的心肌病患者的治疗信息却很匮乏。当前指南指出，这些患者的治疗方式应与射血分数保留的心肌病患者类似。血管紧张素转换酶抑制预防事件（PEACE）试验的数据被用于阐明血管紧张素转换酶（ACE）抑制剂是否能改善缺血性心肌病和射血分数中等的患者的临床结局。
方法
对PEACE试验进行事后亚组分析，以评估ACE抑制剂对缺血性心肌病和射血分数中等（40-50%）的患者亚组的影响。采用卡方检验和学生t检验来检查和比较实验组与对照组之间基线特征和结局的二元变量和连续变量。
结果
我们研究了PEACE试验中缺血性心肌病和射血分数中等的患者亚组（8290名总患者中的2512名）。患者被分配到干预组（n = 1247）或安慰剂组（n = 1265）。两组之间的基线人口统计学和健康特征无显著差异。在总共7年（平均4.7年）的随访期间，使用trandolapril治疗的患者的复合结局[全因死亡率、非致命性心肌梗死和中风；相对风险（RR）0.79，95%置信区间（CI）0.63-0.98；p = 0.03]和全因死亡率（RR 0.85，95%CI 0.73-0.99；p = 0.03）有所降低。
结论
本研究揭示了ACE抑制剂对缺血性心肌病和射血分数中等的患者有益。
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