Abstract 4263: Angiotensin Converting Enzyme Inhibitors in Patients with Coronary Artery Disease and Preserved Left Ventricular Function: A Meta-Analysis of Randomized Controlled Trials.
Background: The Angiotensin Converting Enzyme Inhibitors (ACEIs) have been shown to improve outcomes in patients with heart failure and myocardial infarction. However, there is conflicting evidence concerning the benefits of ACEIs in patients with coronary artery disease (CAD) and preserved LV systolic function.
Methods: PUBMED/EMBASE/CENTRAL search for randomized trials (RCTs) evaluating ACEIs in patients with CAD and preserved LV systolic function (EF >=40%). Outcomes of interest were all-cause mortality, cardiovascular mortality, nonfatal MI, angina pectoris, stroke, heart failure, revascularization, new onset diabetes, heart failure hospitalization, hospitalization for angina and cardiac arrest.
Results: Among 15 RCTs which evaluated 41,480 patients, ACEIs were associated with a 12% reduction in all-cause mortality, 18% reduction in CV mortality, 17% reduction in nonfatal MI, 6% reduction in revascularization, 17% reduction in new onset diabetes, and a 19% reduction in heart failure hospitalization, when compared to controls. However, there was no benefit for the outcomes of angina pectoris, stroke, heart failure, hospitalization for angina and cardiac arrest when compared to controls.
Conclusions: In patients with CAD and preserved LV systolic function, ACEIs results in significant reduction in the risk of major cardiovascular events. ACEIs should be routinely used in patients with CAD regardless of the LV systolic function.