The Survival and Ventricular Enlargement (SAVE) study: rationale and perspective

Myocardial infarction increases the risk of subsequent cardiovascular events (e.g., heart failure or another myocardial infarction) among survivors as compared with the general population. Left ventricular dysfunction is among the major risk factors for such adverse events. Although reductions in cardiovascular risk have been achieved by use of aspirin, beta-blockers (and sometimes revascularization and/or serum lipid-lowering agents), the potential of angiotensin-converting enzyme (ACE) inhibitors to improve the outcome for survivors of myocardial infarction has only recently been examined. The concept that ACE inhibition might be of benefit for these patients originated from animal studies demonstrating that long-term ACE inhibition therapy attenuated left-ventricular enlargement. After clinical confirmation of this initial finding, the Survival and Ventricular Enlargement (SAVE) trial was designed to determine whether long-term ACE inhibition therapy would reduce morbidity and mortality among survivors of myocardial infarction. The SAVE study found the following risk reductions among captopril vs placebo recipients: death (all causes) 19% (95% confidence interval, 3 to 35%; p = 0.019); cardiovascular death 21% (95% confidence interval, 5 to 35%; p = 0.014); myocardial infarction 25% (95% confidence interval, 5 to 40%; p = 0.012). To the list of proved therapies that extend survival following myocardial infarction, the physician can now add ACE inhibition with captopril for patients with left ventricular dysfunction. Survivors of myocardial infarction are at heightened risk for subsequent adverse cardiovascular events.(ABSTRACT TRUNCATED AT 250 WORDS)