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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
Journal of the American College of Cardiology
|March 25, 2000
Summary
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.