Hall A S, Tan L B, Ball S G
Cardiovascular Studies Unit, University of Leeds, United Kingdom.
Cardiovasc Res. 1994 Feb;28(2):190-8. doi: 10.1093/cvr/28.2.190.
Three major trials, in patients with chronic heart failure, have shown that treatment with an ACE inhibitor reduces mortality. However, at the time of writing this review there continue to be strong grounds for uncertainty as to the role of these drugs after acute myocardial infarction in man. This uncertainty is exemplified by the findings of two recently published mortality trials, the CONSENSUS II and the SAVE investigations. Despite virtually identical premises, though widely differing therapeutic approaches, the observations reported in these two papers contrast markedly. In this review we have sought to analyse the possible reasons why the findings of the two trials differ. In our attempt to understand this important issue we have necessarily turned to smaller clinical studies, and also to investigations performed in animals. Furthermore, we review the investigational strategies which have been employed by other, currently unreported, large scale survival studies, as these will certainly hold many of the answers to the questions which the SAVE and CONSENSUS II trials have raised.
三项针对慢性心力衰竭患者的大型试验表明，使用血管紧张素转换酶抑制剂（ACE抑制剂）进行治疗可降低死亡率。然而，在撰写本综述时，对于这些药物在人类急性心肌梗死后所起的作用，仍存在诸多不确定因素。最近发表的两项死亡率试验——CONSENSUS II试验和SAVE研究的结果就例证了这种不确定性。尽管这两项试验的前提几乎相同，但治疗方法却大相径庭，两篇论文中报告的观察结果也形成了鲜明对比。在本综述中，我们试图分析这两项试验结果存在差异的可能原因。为了理解这个重要问题，我们必然要参考规模较小的临床研究以及在动物身上进行的研究。此外，我们还回顾了其他目前尚未报道的大规模生存研究所采用的研究策略，因为这些研究肯定会为SAVE试验和CONSENSUS II试验所提出的问题提供许多答案。
