Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction

Results of the survival and ventricular enlargement trial

Marc A. Pfeffer, Eugene Braunwald, Lemuel A. Moyé, Lofty Basta, Edward J. Brown, Thomas E. Cuddy, Barry R. Davis, Edward M. Geltman, Steven Goldman, Greg C. Flaker, Marc Klein, Gervasio A. Lamas, Milton Packer, Jacques Rouleau, Jean L. Rouleau, John Rutherford, John H. Wertheimer, C. Morton Hawkins

Research output: Contribution to journalArticle

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Abstract

Background. Left ventricular dilatation and dysfunction after myocardial infarction are major predictors of death. In experimental and clinical studies, long-term therapy with the angiotensin-converting-enzyme inhibitor captopril attenuated ventricular dilatation and remodeling. We investigated whether captopril could reduce morbidity and mortality in patients with left ventricular dysfunction after a myocardial infarction. Methods. Within 3 to 16 days after myocardial infarction, 2231 patients with ejection fractions of 40 percent or less but without overt heart failure or symptoms of myocardial ischemia were randomly assigned to receive double-blind treatment with either placebo (1116 patients) or captopril (1115 patients) and were followed for an average of 42 months. Results. Mortality from all causes was significantly reduced in the captopril group (228 deaths, or 20 percent) as compared with the placebo group (275 deaths, or 25 percent); the reduction in risk was 19 percent (95 percent confidence interval, 3 to 32 percent; P = 0.019). In addition, the incidence of both fatal and nonfatal major cardiovascular events was consistently reduced in the captopril group. The reduction in risk was 21 percent (95 percent confidence interval, 5 to 35 percent; P = 0.014) for death from cardiovascular causes, 37 percent (95 percent confidence interval, 20 to 50 percent; P<0.001) for the development of severe heart failure, 22 percent (95 percent confidence interval, 4 to 37 percent; P = 0.019) for congestive heart failure requiring hospitalization, and 25 percent (95 percent confidence interval, 5 to 40 percent; P = 0.015) for recurrent myocardial infarction. Conclusions. In patients with asymptomatic left ventricular dysfunction after myocardial infarction, long-term administration of captopril was associated with an improvement in survival and reduced morbidity and mortality due to major cardiovascular events. These benefits were observed in patients who received thrombolytic therapy, aspirin, or beta-blockers, as well as those who did not, suggesting that treatment with captopril leads to additional improvement in outcome among selected survivors of myocardial infarction.

Original languageEnglish (US)
Pages (from-to)669-677
Number of pages9
JournalNew England Journal of Medicine
Volume327
Issue number10
StatePublished - Sep 3 1992

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Captopril
Left Ventricular Dysfunction
Myocardial Infarction
Morbidity
Survival
Mortality
Confidence Intervals
Heart Failure
Risk Reduction Behavior
Dilatation
Placebos
Ventricular Remodeling
Thrombolytic Therapy
Angiotensin-Converting Enzyme Inhibitors
Aspirin
Myocardial Ischemia
Survivors
Cause of Death
Hospitalization
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

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Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction : Results of the survival and ventricular enlargement trial. / Pfeffer, Marc A.; Braunwald, Eugene; Moyé, Lemuel A.; Basta, Lofty; Brown, Edward J.; Cuddy, Thomas E.; Davis, Barry R.; Geltman, Edward M.; Goldman, Steven; Flaker, Greg C.; Klein, Marc; Lamas, Gervasio A.; Packer, Milton; Rouleau, Jacques; Rouleau, Jean L.; Rutherford, John; Wertheimer, John H.; Hawkins, C. Morton.

In: New England Journal of Medicine, Vol. 327, No. 10, 03.09.1992, p. 669-677.

Research output: Contribution to journalArticle

Pfeffer, MA, Braunwald, E, Moyé, LA, Basta, L, Brown, EJ, Cuddy, TE, Davis, BR, Geltman, EM, Goldman, S, Flaker, GC, Klein, M, Lamas, GA, Packer, M, Rouleau, J, Rouleau, JL, Rutherford, J, Wertheimer, JH & Hawkins, CM 1992, 'Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: Results of the survival and ventricular enlargement trial', New England Journal of Medicine, vol. 327, no. 10, pp. 669-677.
Pfeffer, Marc A. ; Braunwald, Eugene ; Moyé, Lemuel A. ; Basta, Lofty ; Brown, Edward J. ; Cuddy, Thomas E. ; Davis, Barry R. ; Geltman, Edward M. ; Goldman, Steven ; Flaker, Greg C. ; Klein, Marc ; Lamas, Gervasio A. ; Packer, Milton ; Rouleau, Jacques ; Rouleau, Jean L. ; Rutherford, John ; Wertheimer, John H. ; Hawkins, C. Morton. / Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction : Results of the survival and ventricular enlargement trial. In: New England Journal of Medicine. 1992 ; Vol. 327, No. 10. pp. 669-677.
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abstract = "Background. Left ventricular dilatation and dysfunction after myocardial infarction are major predictors of death. In experimental and clinical studies, long-term therapy with the angiotensin-converting-enzyme inhibitor captopril attenuated ventricular dilatation and remodeling. We investigated whether captopril could reduce morbidity and mortality in patients with left ventricular dysfunction after a myocardial infarction. Methods. Within 3 to 16 days after myocardial infarction, 2231 patients with ejection fractions of 40 percent or less but without overt heart failure or symptoms of myocardial ischemia were randomly assigned to receive double-blind treatment with either placebo (1116 patients) or captopril (1115 patients) and were followed for an average of 42 months. Results. Mortality from all causes was significantly reduced in the captopril group (228 deaths, or 20 percent) as compared with the placebo group (275 deaths, or 25 percent); the reduction in risk was 19 percent (95 percent confidence interval, 3 to 32 percent; P = 0.019). In addition, the incidence of both fatal and nonfatal major cardiovascular events was consistently reduced in the captopril group. The reduction in risk was 21 percent (95 percent confidence interval, 5 to 35 percent; P = 0.014) for death from cardiovascular causes, 37 percent (95 percent confidence interval, 20 to 50 percent; P<0.001) for the development of severe heart failure, 22 percent (95 percent confidence interval, 4 to 37 percent; P = 0.019) for congestive heart failure requiring hospitalization, and 25 percent (95 percent confidence interval, 5 to 40 percent; P = 0.015) for recurrent myocardial infarction. Conclusions. In patients with asymptomatic left ventricular dysfunction after myocardial infarction, long-term administration of captopril was associated with an improvement in survival and reduced morbidity and mortality due to major cardiovascular events. These benefits were observed in patients who received thrombolytic therapy, aspirin, or beta-blockers, as well as those who did not, suggesting that treatment with captopril leads to additional improvement in outcome among selected survivors of myocardial infarction.",
author = "Pfeffer, {Marc A.} and Eugene Braunwald and Moy{\'e}, {Lemuel A.} and Lofty Basta and Brown, {Edward J.} and Cuddy, {Thomas E.} and Davis, {Barry R.} and Geltman, {Edward M.} and Steven Goldman and Flaker, {Greg C.} and Marc Klein and Lamas, {Gervasio A.} and Milton Packer and Jacques Rouleau and Rouleau, {Jean L.} and John Rutherford and Wertheimer, {John H.} and Hawkins, {C. Morton}",
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T1 - Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction

T2 - Results of the survival and ventricular enlargement trial

AU - Pfeffer, Marc A.

AU - Braunwald, Eugene

AU - Moyé, Lemuel A.

AU - Basta, Lofty

AU - Brown, Edward J.

AU - Cuddy, Thomas E.

AU - Davis, Barry R.

AU - Geltman, Edward M.

AU - Goldman, Steven

AU - Flaker, Greg C.

AU - Klein, Marc

AU - Lamas, Gervasio A.

AU - Packer, Milton

AU - Rouleau, Jacques

AU - Rouleau, Jean L.

AU - Rutherford, John

AU - Wertheimer, John H.

AU - Hawkins, C. Morton

PY - 1992/9/3

Y1 - 1992/9/3

N2 - Background. Left ventricular dilatation and dysfunction after myocardial infarction are major predictors of death. In experimental and clinical studies, long-term therapy with the angiotensin-converting-enzyme inhibitor captopril attenuated ventricular dilatation and remodeling. We investigated whether captopril could reduce morbidity and mortality in patients with left ventricular dysfunction after a myocardial infarction. Methods. Within 3 to 16 days after myocardial infarction, 2231 patients with ejection fractions of 40 percent or less but without overt heart failure or symptoms of myocardial ischemia were randomly assigned to receive double-blind treatment with either placebo (1116 patients) or captopril (1115 patients) and were followed for an average of 42 months. Results. Mortality from all causes was significantly reduced in the captopril group (228 deaths, or 20 percent) as compared with the placebo group (275 deaths, or 25 percent); the reduction in risk was 19 percent (95 percent confidence interval, 3 to 32 percent; P = 0.019). In addition, the incidence of both fatal and nonfatal major cardiovascular events was consistently reduced in the captopril group. The reduction in risk was 21 percent (95 percent confidence interval, 5 to 35 percent; P = 0.014) for death from cardiovascular causes, 37 percent (95 percent confidence interval, 20 to 50 percent; P<0.001) for the development of severe heart failure, 22 percent (95 percent confidence interval, 4 to 37 percent; P = 0.019) for congestive heart failure requiring hospitalization, and 25 percent (95 percent confidence interval, 5 to 40 percent; P = 0.015) for recurrent myocardial infarction. Conclusions. In patients with asymptomatic left ventricular dysfunction after myocardial infarction, long-term administration of captopril was associated with an improvement in survival and reduced morbidity and mortality due to major cardiovascular events. These benefits were observed in patients who received thrombolytic therapy, aspirin, or beta-blockers, as well as those who did not, suggesting that treatment with captopril leads to additional improvement in outcome among selected survivors of myocardial infarction.

AB - Background. Left ventricular dilatation and dysfunction after myocardial infarction are major predictors of death. In experimental and clinical studies, long-term therapy with the angiotensin-converting-enzyme inhibitor captopril attenuated ventricular dilatation and remodeling. We investigated whether captopril could reduce morbidity and mortality in patients with left ventricular dysfunction after a myocardial infarction. Methods. Within 3 to 16 days after myocardial infarction, 2231 patients with ejection fractions of 40 percent or less but without overt heart failure or symptoms of myocardial ischemia were randomly assigned to receive double-blind treatment with either placebo (1116 patients) or captopril (1115 patients) and were followed for an average of 42 months. Results. Mortality from all causes was significantly reduced in the captopril group (228 deaths, or 20 percent) as compared with the placebo group (275 deaths, or 25 percent); the reduction in risk was 19 percent (95 percent confidence interval, 3 to 32 percent; P = 0.019). In addition, the incidence of both fatal and nonfatal major cardiovascular events was consistently reduced in the captopril group. The reduction in risk was 21 percent (95 percent confidence interval, 5 to 35 percent; P = 0.014) for death from cardiovascular causes, 37 percent (95 percent confidence interval, 20 to 50 percent; P<0.001) for the development of severe heart failure, 22 percent (95 percent confidence interval, 4 to 37 percent; P = 0.019) for congestive heart failure requiring hospitalization, and 25 percent (95 percent confidence interval, 5 to 40 percent; P = 0.015) for recurrent myocardial infarction. Conclusions. In patients with asymptomatic left ventricular dysfunction after myocardial infarction, long-term administration of captopril was associated with an improvement in survival and reduced morbidity and mortality due to major cardiovascular events. These benefits were observed in patients who received thrombolytic therapy, aspirin, or beta-blockers, as well as those who did not, suggesting that treatment with captopril leads to additional improvement in outcome among selected survivors of myocardial infarction.

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