Ramipril treatment for an average of 13 months in patients with AMI and heart failure provided a sustained survival benefit, extending life by 14.5 months (95% CI 13.2 to 15.8).
RCT (n=603)
Masked
Randomly allocated
Does ramipril improve long-term survival in patients with acute myocardial infarction complicated by heart failure?
Ramipril provides a sustained long-term survival benefit, extending life by up to 14.5 months in patients with heart failure following an acute myocardial infarction, despite an average initial treatment duration of only 13 months.
Effect estimate: Extension of life 14.5 months (95% CI 13.2 to 15.8)
Absolute Event Rate: 91.1% vs 88.4%
AIMS: ACE inhibition reduces mortality and morbidity in patients with heart failure after acute myocardial infarction (AMI). However, there are limited randomised data about the long-term survival benefits of ACE inhibition in this population. METHODS: In 1993, the Acute Infarction Ramipril Efficacy (AIRE) study randomly allocated patients with AMI and clinical heart failure to ramipril or placebo. The duration of masked trial therapy in the UK cohort (603 patients, mean age=64.7 years, 455 male patients) was 12.4 and 13.4 months for ramipril (n=302) and placebo (n=301), respectively. We estimated life expectancy and extensions of life (difference in median survival times) according to duration of follow-up (range 0-29.6 years). RESULTS: By 9 April 2019, death from all causes occurred in 266 (88.4%) patients in placebo arm and 275 (91.1%) patients in ramipril arm. The extension of life between ramipril and placebo groups was 14.5 months (95% CI 13.2 to 15.8). Ramipril increased life expectancy more for patients with than without diabetes (life expectancy difference 32.1 vs 5.0 months), previous AMI (20.1 vs 4.9 months), previous heart failure (19.5 vs 4.9 months), hypertension (16.6 vs 8.3 months), angina (16.2 vs 5.0 months) and age >65 years (11.3 vs 5.7 months). Given potential treatment switching, the true absolute treatment effect could be underestimated by 28%. CONCLUSION: For patients with clinically defined heart failure following AMI, ramipril results in a sustained survival benefit, and is associated with an extension of life of up to 14.5 months for, on average, 13 months treatment duration.
Wu et al. (Fri,) conducted a rct in Acute myocardial infarction complicated by heart failure (n=603). Ramipril vs. Placebo was evaluated on Death from all causes and extension of life (difference in median survival times) (Extension of life 14.5 months, 95% CI 13.2 to 15.8). Ramipril treatment for an average of 13 months in patients with AMI and heart failure provided a sustained survival benefit, extending life by 14.5 months (95% CI 13.2 to 15.8).
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