Effects of Perindopril on Long-Term Clinical Outcome of Patients With Coronary Artery Disease and Left Ventricular Function
Michel E. Bertrand, Wilhelm J. Remme, Roberto Ferrari, Jaap W. Deckers, Maarten L. Simoons, Kim M. Fox, Lille Heart Institute, Lille, France
Stable Ischemic Syndrome
Background: Background: The EUROPA trial has demonstrated that perindopril, an ACE inhibitor with high-tissue affinity, was able to significantly decrease the risk of major cardiac events in patients (pts) with stable coronary heart disease (SCAD) without apparent heart failure
Aim: To assess the long-term clinical outcome of pts with SCAD and preserved left ventricular function (left ventricular ejection fraction (LVEF)>40%).
Methods: A retrospective evaluation of LVEF was performed in the EUROPA study population. Among the 12,218 pts of EUROPA, we identified 7,096 (58%) pts who had LVEF measurement before randomization. Two groups of pts were studied: 6,878 (97 %) pts with LVEF > 40% (3,429 received 8 mg of perindopril and 3,449 received a placebo) and 218 pts (3%) with a LVEF 40%), there was a significant relative risk reduction of 16 % of the primary endpoint (a composite of cardiovascular death, non fatal myocardial infarction (MI) and resuscitated cardiac arrest) in the group treated with perindopril (8.3%) in comparison to the group treated with placebo (9.8%): Hazard ratio (HR) =0.84 [95% CI: 0.72-0.99] p=0.033). Similar results were obtained for the first secondary endpoint (total mortality, non-fatal MI, hospital admission for unstable angina and cardiac arrest with successful resuscitation): HR=0.85 [95% CI: 0.76-0.96] p=0.008, for cardiovascular mortality and non fatal MI: HR=0.84 [95% CI: 0.72-0.99] p=0.036.
Similar benefits were observed in pts with an LVEF > 40% and a history of previous MI and in pts with an LVEF < 40%.
Conclusions: LVEF was documented in 58% of the EUROPA study population and only 3% had an impaired LV function, confirming that EUROPA pts did not have asymptomatic LV dysfunction. Results in pts with preserved LV function are consistent with those of the whole EUROPA study population and perindopril 8mg is beneficial in all pts with stable coronary artery disease.
Keywords: ACE inhibitor,Prevention,Coronary artery disease