Effects of the Early Administration of Enalapril on Mortality in Patients with Acute Myocardial Infarction
Why the study?
Does early administration of enalapril reduce mortality in patients with acute myocardial infarction?
Population
6,090 patients with acute myocardial infarctions and blood pressure above 100/60 mm Hg across 103…
Comparison
Enalapril in addition to conventional therapy. vs Placebo in addition to conventional therapy.
Design
RCT, Randomly assigned
Follow-up
6 months
Authors
Discussion
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Implication
Early enalapril after acute MI does not reduce 6-month mortality and increases hypotension; challenges immediate ACE inhibitor initiation.
Key Points
- To evaluate whether initiating the ACE inhibitor enalapril within 24 hours of an acute myocardial infarction reduces mortality over a six-month follow-up period.
- Multicenter randomized trial conducted across 103 Scandinavian centers enrolling 6,090 patients with acute myocardial infarction and blood pressure above 100/60 mm Hg.
- Patients were randomly assigned within 24 hours of chest pain onset to receive intravenous enalaprilat followed by oral enalapril (N=3,044) or placebo (N=3,046) in addition to conventional care.
- Life-table mortality at six months was 11.0% with enalapril versus 10.2% with placebo (RR 1.10, 95% CI 0.93 to 1.29, P=0.26), and one-month mortality was 7.2% versus 6.3%, respectively.
- Early hypotension occurred in 12% of the enalapril group compared to 3% of the placebo group (P<0.001), while deaths due to progressive heart failure were 4.3% versus 3.4% (P=0.06).
- Worsening heart failure prompted therapy changes in 27% of patients receiving enalapril compared to 30% receiving placebo (P<0.006).
Structured PICO
Does early administration of enalapril reduce mortality in patients with acute myocardial infarction?
P
Population
6,090 patients with acute myocardial infarctions and blood pressure above 100/60 mm Hg across 103 Scandinavian centers.
I
Intervention
Enalapril (intravenous enalaprilat initiated within 24 hours after the onset of chest pain, followed by oral enalapril) in addition to conventional therapy.
C
Comparator
Placebo in addition to conventional therapy.
O
Outcome
Mortality at 6 months (180 days) after acute myocardial infarction.hard clinical
Early administration of enalapril within 24 hours of acute myocardial infarction does not improve 6-month survival and significantly increases the risk of early hypotension.
Cite This Study
Held et al. (1992) studied this question.