Clinical effects of early angiotensin-converting enzyme inhibitor treatment for acute myocardial infarction are similar in the presence and absence of aspirin

Roberto Latini, Gianni Tognoni, Aldo P. Maggioni, Colin Baigent, Eugene Braunwald, Zheng Ming Chen, Rory Collins, Marcus Flather, Mariagrazia Franzosi, John Kjekshus, Lars Køber, Li Sheng Liu, Richard Peto, Marc Pfeffer, Fabrizio Pizzetti, Eugenio Santoro, Peter Sleight, Karl Swedberg, Luigi Tavazzi, Wen WangSalim Yusuf

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives. We sought to determine whether the clinical effects of early angiotensin-converting enzyme (ACE) inhibitor (ACEi) treatment for acute myocardial infarction (MI) are influenced by the concomitant use of aspirin (ASA). Background. Aspirin and ACEi both reduce mortality when given early after MI. Aspirin inhibits the synthesis of vasodilating prostaglandins, and, in principle, this inhibition might antagonize some of the effects of ACEi. But it is uncertain whether, in practice, this influences the effects of ACEi on mortality and major morbidity after MI. Methods. This overview sought individual patient data from all trials involving more than 1,000 patients randomly allocated to receive ACEi or control starting in the acute phase of MI (0-36 h from onset) and continuing for four to six weeks. Data on concomitant ASA use were available for 96,712 of 98,496 patients in four eligible trials (and for none of 1,556 patients in the one other eligible trial). Results. Overall 30-day mortality was 7.1% among patients allocated to ACEi and 7.6% among those allocated to control, corresponding to a 7% (standard deviation [SD], 2%) proportional reduction (95% confidence interval 2% to 11%, p = 0.004). Angiotensin-converting enzyme inhibitor was associated with similar proportional reductions in 30-day mortality among the 86,484 patients who were taking ASA (6% [SD, 3%] reduction) and the 10,228 patients who were not (10% [SD, 5%] reduction: chi-squared test of heterogeneity between these reductions = 0.4; p = 0.5). Angiotensin-converting enzyme inhibitor produced definite increases in the incidence of persistent hypotension (17.9% ACEi vs. 9.4% control) and of renal dysfunction (1.3% ACEi vs. 0.6% control), but there was no good evidence that these effects were different in the presence or absence of ASA (chi-squared for heterogeneity = 0.4 and 0.0, respectively; both not significant). Nor was there good evidence that the effects of ACEi on other clinical outcomes were changed by concomitant ASA use. Conclusions. Both ASA and ACEi are beneficial in acute MI. The present results support the early use of ACEi in acute MI, irrespective of whether or not ASA is being given. (C) 2000 by the American College of Cardiology.

Original languageEnglish
Pages (from-to)1801-1807
Number of pages7
JournalJournal of the American College of Cardiology
Volume35
Issue number7
DOIs
Publication statusPublished - Jun 2000

ASJC Scopus subject areas

  • Nursing(all)

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