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The Angiotensin-converting Enzyme Inhibition Post Revascularization Study (APRES)
L Kjøller-Hansen1, R Steffensen, P Grande
1The Heart Center, Rigshospitalet, Copenhagen, Denmark. kjol-h@dadlnet.dk
Insights
Ramipril significantly reduced cardiac events like death, heart attack, or heart failure in patients with moderate left ventricular dysfunction after revascularization. This study shows angiotensin-converting enzyme inhibitor benefits extend to this patient group.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Patients with angina and left ventricular dysfunction benefit from revascularization and ACE inhibitors.
- The combined effect of these strategies was previously unevaluated.
Purpose of the Study:
- To evaluate ramipril's impact on cardiac events post-invasive revascularization.
- To assess ramipril's efficacy in asymptomatic patients with moderate left ventricular dysfunction.
Main Methods:
- 159 patients with specific criteria underwent invasive revascularization.
- Patients were randomized to receive either ramipril or placebo in a double-blind manner.
- Follow-up was conducted for a median of 33 months.
Main Results:
- Ramipril significantly lowered the risk of cardiac death, myocardial infarction, or heart failure by 58% (p=0.031).
- No significant difference was observed for the quadruple-composite endpoint including recurrent angina.
- Results were consistent across subgroups based on ejection fraction and revascularization method.
Conclusions:
- Long-term ramipril treatment after revascularization benefits patients with angina and asymptomatic moderate left ventricular dysfunction.
- ACE inhibitor therapy is beneficial for this specific patient population.
- Ramipril reduces major adverse cardiac events in this high-risk group.
Objective:
This study was performed to assess the effect of treatment with ramipril on the incidence of cardiac events after invasive revascularization in patients with asymptomatic moderate left ventricular dysfunction.
Background:
In patients with angina pectoris and left ventricular dysfunction, both invasive revascularization and treatment with angiotensin-converting enzyme inhibitors reduce cardiac mortality and morbidity. Whether there is a benefit from combining the two treatment strategies has never been evaluated prospectively.
Methods:
After invasive revascularization, 159 patients with preoperative chronic stable angina pectoris, left ventricular ejection fraction between 0.30 and 0.50 and no clinical heart failure were randomly assigned to receive double-blind treatment with either ramipril or placebo and subsequently followed for a median of 33 months.
Results:
Ramipril reduced the incidence of the triple-composite end point of cardiac death, acute myocardial infarction or clinical heart failure (risk reduction 58%; 95% confidence interval 7% to 80%, p = 0.031). The incidence of the quadruple-composite end point of cardiac death, acute myocardial infarction, clinical heart failure or recurrent angina pectoris was not altered with ramipril. These findings were consistent across subgroups with respect to left ventricular ejection fraction below or above 0.40, and whether coronary artery bypass grafting or percutaneous transluminal coronary angioplasty was performed.
Conclusions:
In patients with angina pectoris and asymptomatic moderate left ventricular dysfunction, long-term treatment with ramipril after invasive revascularization significantly reduced the incidence of the composite end point of cardiac death, acute myocardial infarction or clinical heart failure, indicating that the beneficial effects of angiotensin-converting enzyme inhibitor treatment may be extended to include treatment of this patient group.