Abstract 17212: Effect of Enalapril on Long-Term Survival among Patients with Left Ventricular Systolic Dysfunction: a 25-Year Near-Full Life-Cycle Follow-Up of SOLVD in Belgium
BACKGROUND: We previously reported that in-trial enalapril therapy was associated with a post-trial mortality benefit in a 12-year follow-up of the Studies of Left Ventricular Dysfunction (SOLVD). We reported here the effect of enalapril on long-term survival in a SOLVD cohort from Belgium that had reached a near-full life-cycle follow-up after 25 years.
METHODS: Among the 558 Belgium patients originally enrolled in SOLVD (398 in prevention arm and 160 in treatment arm), post-trial mortality data were prospectively collected on all 433 survivors (218 in enalapril group vs. 215 in placebo group) at closeout. All patients received enalapril therapy after the trial ended.
RESULTS: No patients were lost to follow-up. The median duration of follow-up was 25.3 years since randomization or 22.1 years since closeout. In all, 91% of patients had died. Kaplan-Meier event rate for all-cause mortality was lower in the enalapril group than the placebo group over the entire follow-up period (88% vs. 94%, p=0.02). When stratified by trial arms, in-trial enalapril therapy was associated with a 20% relative risk reduction in death from any cause as compared to placebo (HR 0.80, p=0.01). Exhaustion analysis from the time of closeout showed that the mortality benefit of enalapril was sustained over the post-trial period (84% vs. 92%, p=0.008). Life expectancy was increased by a median of 28.3 (95% CI 7.5-53.7) months among patients who initially received enalapril as compared to placebo. Post-trial ACE inhibitor usage (74%) was similar between the two groups (p=0.29).
CONCLUSIONS: In this rare near-full life-cycle follow-up of SOLVD in Belgium, in-trial enalapril therapy was associated with a long-term post-trial mortality benefit that was sustained for 25 years among patients with left ventricular systolic dysfunction.
Author Disclosures: S.A. Ahn: None. P. Jong: None. H. Pouleur: None. M.F. Rousseau: None.
- © 2014 by American Heart Association, Inc.