Køber L, Torp-Pedersen C T, Carlsen J E, Bagger H, Eliasen P, Lyngborg K, Videbaek J
Kardiologisk afdeling, Amtssygehuset i Gentofte.
Ugeskr Laeger. 1997 Mar 10;159(11):1616-22.
Angiotensin converting-enzyme (ACE) inhibition reduces mortality among patients surviving an acute myocardial infarction, but whether to give ACE-inhibitors to all patients or target their use to selected patients is unclear. Seven thousand and one consecutive enzyme-confirmed myocardial infarctions were screened. One thousand seven hundred and forty-nine patients with echocardiographic signs of left ventricular dysfunction were randomized to oral trandolapril (876 patients) or placebo (873 patients) starting from days three to seven following the infarction. Average follow-up was 27 months. There were 304 deaths (34.7 percent) among patients on trandolapril vs. 369 deaths (42.3 percent) among patients on placebo (p = 0.0013). Relative risk (RR) of death in the trandolapril group was 0.78 (95% confidence interval (CD 0.67-0.91). Trandolapril reduced cardiovascular death (RR 0.75, CI 0.63-0.89) and sudden death (RR 0.76, CI 0.59-0.98). Progression to severe/resistant heart failure was reduced (RR 0.71, CI 0.56-0.90). Recurrent myocardial infarction (fatal or non-fatal) was not significantly reduced (RR 0.86, CI 0.66-1.13). It is concluded that long-term treatment with trandolapril in patients with reduced left ventricular function shortly after myocardial infarction significantly reduced total mortality. The substantial mortality risk reduction was obtained in 25% of consecutive patients screened for entry encouraging a selective use of ACE inhibition following myocardial infarction.
血管紧张素转换酶（ACE）抑制剂可降低急性心肌梗死后存活患者的死亡率，但对于是将ACE抑制剂用于所有患者还是仅用于特定患者尚不清楚。对7001例连续经酶证实的心肌梗死患者进行了筛查。1749例有左心室功能障碍超声心动图表现的患者被随机分为两组，从心肌梗死后第3至7天开始，分别口服群多普利（876例患者）或安慰剂（873例患者）。平均随访27个月。群多普利组有304例死亡（34.7%），而安慰剂组有369例死亡（42.3%）（p = 0.0013）。群多普利组的死亡相对风险（RR）为0.78（95%置信区间（CI）0.67 - 0.91）。群多普利降低了心血管死亡（RR 0.75，CI 0.63 - 0.89）和猝死（RR 0.76，CI 0.59 - 0.98）。进展为严重/顽固性心力衰竭的情况减少（RR 0.71，CI 0.56 - 0.90）。复发性心肌梗死（致命或非致命）未显著减少（RR 0.86，CI 0.66 - 1.13）。得出的结论是，心肌梗死后不久左心室功能降低的患者长期使用群多普利治疗可显著降低总死亡率。在25%连续入选筛查的患者中获得了显著的死亡风险降低，这鼓励在心肌梗死后选择性使用ACE抑制剂。
