Abstract 17147: Angiotensin-Converting Enzyme Inhibitors in Patients With Coronary Artery Disease and No Clinical Evidence of Heart Failure: A Meta-Analysis of Randomized Controlled Trials
Data from randomized controlled trials of angiotensin-converting enzyme inhibitors (ACEi) in patients with coronary artery disease (CAD) but no clinical evidence of heart failure are inconclusive. This study was undertaken to more clearly define the role of ACEi in both the acute and chronic CAD setting, in patients without clinical evidence of heart failure. We selected randomized controlled trials with ACEi as the single intervention, focusing on patients with CAD including patients with left ventricular dysfunction but no clinical evidence of heart failure according to ACC/AHA heart failure criteria. The MEDLINE database was searched for all publications between 1/1/1980 and 12/31/2012 with searched terms including angiotensin-converting enzyme inhibitors, coronary artery disease, cardiovascular events, and myocardial infarction (MI). The publications were filtered for randomized controlled trials, multicenter studies, controlled clinical trials, and adult human subjects. A total of 117 were reviewed, of which 9 met the inclusion criteria for a total of 46,337 randomized patients followed for a mean of 36 months. Of the 9 trials, three included were post-MI patients and two were post-revascularization patients. The remaining studies included both acute and chronic CAD patients with varying degree of medical optimization. Treatment with ACEi across the 9 trials was associated with decreased cardiovascular mortality (relative risk 0.82; 95% confidence interval, 0.75-0.89) and all-cause mortality (relative risk 0.86; 95% confidence interval, 0.81-0.92). No significant reduction in other endpoints, including MI (relative risk 0.96; 95% confidence interval, 0.80-1.14) or stroke (relative risk 0.92; 95% confidence interval, 0.7-1.21) was demonstrated. ACE inhibitors reduce cardiovascular and all-cause mortality in CAD patients without clinical evidence of heart failure. This is true regardless of CAD acuity. ACE inhibitors are not associated with a reduction in other cardiovascular endpoints, including MI, in this population, suggesting that the benefit of ACE inhibitors in low-risk CAD patients may be less significant.
- © 2013 by American Heart Association, Inc.