Document Detail

Mortality rates in elderly patients who take different angiotensin-converting enzyme inhibitors after acute myocardial infarction: a class effect?
MedLine Citation:
PMID:  15262665     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Several randomized, controlled trials show that angiotensin-converting enzyme (ACE) inhibitors improve survival in patients who have had an acute myocardial infarction. However, existing data from trials do not address whether all ACE inhibitors benefit patients similarly. OBJECTIVE: To evaluate whether all ACE inhibitors are associated with similar mortality in patients 65 years of age or older who have had an acute myocardial infarction. DESIGN: Retrospective cohort study that used linked hospital discharge and prescription databases containing information on 18 453 patients 65 years of age or older who were admitted for an acute myocardial infarction between 1 April 1996 and 31 March 2000. SETTING: 109 hospitals in Quebec, Canada. PATIENTS: 7512 patients who filled a prescription for an ACE inhibitor within 30 days of discharge and who continued to receive the same drug for at least 1 year. MEASUREMENTS: The association between the specific drugs and clinical outcomes was measured by using Cox proportional hazards models, with adjustment for demographic, clinical, physician, and hospital variables and dosage categories, represented by time-dependent variables. RESULTS: Enalapril, fosinopril, captopril, quinapril, and lisinopril were associated with higher mortality than was ramipril; the adjusted hazard ratios and 95% CIs were 1.47 (95% CI, 1.14 to 1.89), 1.71 (CI, 1.29 to 2.25), 1.56 (CI, 1.13 to 2.15), 1.58 (CI, 1.10 to 2.82), and 1.28 (CI, 0.98 to 1.67), respectively. The adjusted hazard ratio associated with perindopril was 0.98 (CI, 0.60 to 1.60). LIMITATIONS: The administrative databases did not contain detailed clinical information, and unmeasured factors associated with a patient's risk for death may have influenced physicians' prescription choices. CONCLUSION: Survival benefits in the first year after acute myocardial infarction in patients 65 years of age or older seem to differ according to the specific ACE inhibitor prescribed. Ramipril was associated with lower mortality than most other ACE inhibitors.
Louise Pilote; Michal Abrahamowicz; Eric Rodrigues; Mark J Eisenberg; Elham Rahme
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of internal medicine     Volume:  141     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-07-20     Completed Date:  2004-07-27     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  102-12     Citation Subset:  AIM; IM    
The Montreal General Hospital, Jewish General Hospital, and McGill University, Montreal, Quebec, Canada.
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / chemistry,  pharmacology,  therapeutic use*
Databases as Topic
Molecular Structure
Myocardial Infarction / drug therapy*,  mortality*
Patient Discharge
Proportional Hazards Models
Recurrence / prevention & control
Retrospective Studies
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors
Comment In:
Ann Intern Med. 2004 Jul 20;141(2):I34   [PMID:  15262682 ]
Ann Intern Med. 2005 Jan 4;142(1):78; author reply 78-9   [PMID:  15630114 ]
Ann Intern Med. 2005 Jan 4;142(1):78; author reply 78-9   [PMID:  15630113 ]
Ann Intern Med. 2004 Jul 20;141(2):157-8   [PMID:  15262673 ]

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