A prospective systematic review 1 assessing individual patient data of the SAVE, AIRE, TRACE and SOLVD trials included a total of 12 763 patients. The follow-up period averaged 35 months. In the three post-infarction trials mortality was lower with ACE inhibitors than with placebo (23.4% vs 29.1%, OR 0.74, 95% CI 0.66 to 0.83), as were rates of readmission for heart failure (11.9% vs 15.5%, OR 0.73, 95% CI 0.63 to 0.85), and reinfarction (10.8% vs 13.2%, OR 0.80, 95% CI 0.69 to 0.94). In all five trials the ACE inhibitor group had lower rates of death than the placebo group and lower rates for reinfarction, readmission for heart failure and the composite of these events (33.8% vs 41.0%, OR 0.72, 95% CI 0.67 to 0.78). The benefits of treatment on all outcomes were independent of age, sex, and baseline use of diuretics, aspirin, and beta-blockers.
Another systematic review 2 including 32 studies with a total of 7 105 subjects was abstracted in DARE. The death rate was 15.8% among patients receiving ACE inhibitors and 21.0% among controls (OR 0.77, 95% CI 0.67 to 0.88). Most of the benefit occurred in the first 90 days. 22.4% of the patients in the ACE inhibitor group died or were hospitalised for congestive heart failure compared to 32.6% of the controls (OR 0.65, 95% CI 0.57 to 0.74). The OR for total mortality in treated vs control patients with ejection fraction <0.25 was 0.69 (95% CI 0.57 to 0.85), whereas for those with EF>0.25 the OR was 0.98 (95% CI 0.78 to 1.23). For the combined endpoint of total mortality or hospitalisation for CHF, the OR for patients with EF <0.25 was 0.53 (95% CI 0.43 to 0.65) while that for patients with EF >0.25 was 0.85 (95% CI 0.69 to 1.04).
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