Abstract 17416: Enalapril Therapy Improved Late Survival in Patients With Asymptomatic or Minimally Symptomatic Left Ventricular Systolic Dysfunction: A 24-Year Follow-up of SOLVD in Belgium
BACKGROUND: In the Studies of Left Ventricular Dysfunction (SOLVD), enalapril therapy did not significantly reduce mortality during the original trial period in patients with left ventricular systolic dysfunction who were asymptomatic or only minimally symptomatic. We reported here the mortality outcomes in a 24-year follow-up of such patients from a SOLVD cohort in Belgium.
METHODS: Among the 398 patients (199 in enalapril vs. 199 in placebo group) originally enrolled in the SOLVD Prevention Trial from Belgium, post-trial mortality data were prospectively collected on all 336 survivors at trial closeout. All patients received enalapril therapy after the trial ended. Use of enalapril was classified as either "early" if started in trial or "delayed" if started post trial. The median delay in therapy was 3.3 years. No patients were lost to follow-up.
RESULTS: The median duration of follow-up was 23.9 years from the time of randomization or 21.0 years from the time of closeout. Kaplan-Meier event rates for all-cause mortality did not differ significantly over the combined in-trial and post-trial follow-up periods between patients who received early as compared to delayed therapy (84% vs. 90%, p=0.11) but differed significantly over the post-trial period in favor of early therapy (81% vs. 88%, p=0.007). Early therapy was associated with a significant 24% (95% CI 4-40%, p=0.02) risk reduction in all-cause mortality over the post-trial period. The mortality benefit was due to a reduction in deaths from progressive heart failure (16% vs. 30%, p=0.002) but not deaths from arrhythmia or sudden deaths (27% vs. 30%, p=0.06). Post-trial use of ACE inhibitors (75%) was similar between the two groups (p=0.18).
CONCLUSIONS: In a 24-year follow-up of SOLVD, early initiation of enalapril therapy reduced late mortality in patients with asymptomatic or minimally symptomatic left ventricular systolic dysfunction.
- © 2013 by American Heart Association, Inc.