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The Survival and Ventricular Enlargement (SAVE) study: rationale and perspective
1Harvard Medical School, Boston, Massachusetts.
Insights
Angiotensin-converting enzyme (ACE) inhibitors, like captopril, significantly reduce death and cardiovascular events in myocardial infarction survivors with left ventricular dysfunction. This therapy offers improved outcomes for high-risk patients post-heart attack.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Myocardial infarction survivors face elevated risks of subsequent cardiovascular events, including heart failure.
- Left ventricular dysfunction is a primary risk factor for adverse outcomes post-myocardial infarction.
- While aspirin and beta-blockers are established therapies, the role of ACE inhibitors in improving outcomes for these patients was under investigation.
Purpose of the Study:
- To evaluate the efficacy of long-term angiotensin-converting enzyme (ACE) inhibition therapy in reducing morbidity and mortality among myocardial infarction survivors.
- To determine if captopril, an ACE inhibitor, improves outcomes in patients with left ventricular dysfunction after myocardial infarction.
Main Methods:
- The Survival and Ventricular Enlargement (SAVE) trial was conducted to assess the impact of long-term ACE inhibition.
- Captopril was administered to patients, and outcomes were compared against a placebo group.
Main Results:
- Captopril therapy resulted in a 19% reduction in all-cause mortality (p=0.019).
- Cardiovascular death was reduced by 21% (p=0.014) and subsequent myocardial infarction by 25% (p=0.012) in the captopril group compared to placebo.
- These risk reductions were observed in patients with left ventricular dysfunction post-myocardial infarction.
Conclusions:
- Angiotensin-converting enzyme (ACE) inhibition with captopril is a proven therapy for extending survival in myocardial infarction survivors.
- Physicians can now incorporate ACE inhibition with captopril into treatment plans for patients experiencing left ventricular dysfunction after a heart attack.
Abstract:
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)