What question did this study set out to answer?

To assess the effects of ramipril on morbidity, mode of death, and progression of heart failure among survivors of acute myocardial infarction.

January 1, 1997European Heart JournalOpen Access

Effect of ramipril on morbidity and mode of death among survivors of acute myocardial infarction with clinical evidence of heart failure

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Why the study?

Does ramipril reduce morbidity and mortality in patients with clinical or radiological evidence of heart failure within 2-9 days of a myocardial infarction?

Key Points

To assess the effects of ramipril on morbidity, mode of death, and progression of heart failure among survivors of acute myocardial infarction.
Randomized, double-blind, placebo-controlled trial (AIRE study) enrolling 2,006 patients with clinical or radiological signs of heart failure 2 to 9 days after acute myocardial infarction.
Participants were assigned to receive ramipril 5 mg twice daily or matching placebo, with primary endpoints adjudicated by an independent, blinded committee.
Ramipril significantly decreased the incidence of severe resistant heart failure as a first validated endpoint compared with placebo (143 vs 178 patients; risk reduction 23%, 95% CI 5%–39%, P=0.017).
Risk of sudden death was significantly lower with ramipril (risk reduction 30%, 95% CI 8%–47%, P=0.011), whereas reduction in death from circulatory failure did not reach statistical significance (risk reduction 18%, 95% CI -14% to 41%, P=0.237).
Ramipril did not alter reinfarction or stroke rates, and 38% of the reduction in total mortality occurred among patients with sudden death who had prior severe resistant heart failure.

Structured PICO

Does ramipril reduce morbidity and mortality in patients with clinical or radiological evidence of heart failure within 2-9 days of a myocardial infarction?

Population

2006 patients with clinical or radiological evidence of heart failure within 2-9 days of a myocardial infarction

Intervention

Ramipril 5 mg twice daily (b.d.)

Comparator

Matching placebo

Outcome

Development of severe resistant heart failure as first validated end-point, and mode of death (sudden death, death from circulatory failure)hard clinical

Ramipril significantly reduces the progression to resistant heart failure and the risk of sudden death in patients with heart failure early after a myocardial infarction.

Discussion

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Implication

Supports early ramipril use in post-MI HF; confirms ACEI benefit on resistant HF progression and sudden death.

Cite This Study

Cleland et al. (1997) studied this question.

synapsesocial.com/papers/69fd29ba30a474415f89e1fa https://doi.org/10.1093/eurheartj/18.1.41

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Effect of ramipril on morbidity and mode of death among survivors of acute myocardial infarction with clinical evidence of heart failure

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Effect of ramipril on morbidity and mode of death among survivors of acute myocardial infarction with clinical evidence of heart failure

Key Points

Structured PICO

Discussion

Implication

Cite This Study

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