Document Detail

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.
MedLine Citation:
PMID:  16606817     Owner:  NLM     Status:  MEDLINE    
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.
Nicolas Danchin; Michel Cucherat; Christian Thuillez; Eric Durand; Zena Kadri; Philippe G Steg
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Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  Archives of internal medicine     Volume:  166     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-04-11     Completed Date:  2006-05-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  787-96     Citation Subset:  AIM; IM    
Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Coronary Artery Disease / prevention & control
Coronary Disease / drug therapy*,  prevention & control
Hospitalization / statistics & numerical data
Indoles / therapeutic use
Middle Aged
Randomized Controlled Trials as Topic
Stroke / prevention & control
Treatment Outcome
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Indoles; 87679-37-6/trandolapril
Comment In:
J Fam Pract. 2006 Aug;55(8):665   [PMID:  17152141 ]
ACP J Club. 2006 Sep-Oct;145(2):32   [PMID:  16944852 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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