Effects of Perindopril on Cardiac Events in Revascularized Coronary Artery Disease Patients
Maarten L. Simoons, Michel E. Bertrand, Willem J. Remme, Jaap W. Deckers, Roberto Ferrari, Kim M. Fox, Erasmus MC, Rotterdam, The Netherlands, Hopital Cardiologique, Lille, France
Stable Ischemic Syndrome
Background: The EUROPA trial has demonstrated that perindopril 8 mg once daily, an ACE inhibitor with high-tissue affinity, significantly decreased the risk of major cardiac events (cardio-vascular death, myocardial infarction and resuscitated cardiac arrest) by 20% in patients with stable coronary heart disease (CAD) without apparent heart failure.
Aim: To assess the effect on cardiac events adding perindopril 8 mg once daily to standard therapy in the subgroup of EUROPA patients, with previous revascularization, and without previous myocardial infarction (MI).
Methods: We conducted a subgroup analysis of the EUROPA study patients according to their revascularization and previous MI history. Among the 12,218 patients of EUROPA, we identified 6709 (54.9%) patients who had a previous revascularization. Approximately equal proportions had undergone PCI (3122) or CABG (3136). As well we identified 3047 (24.9%) patients had not experienced a previous myocardial infarction.
Results: Out of the 6709 revascularized patients, 3340 were treated with perindopril (8 mg per day), 3369 with placebo. Their baseline characteristics were similar to the whole EUROPA population in terms of demographics, medical history, physical examination (heart rate, blood pressure), and medications at screening. The mean patient age was 60 years and 85 % were men.
The incidence of the composite endpoint CV death, MI and resuscitated cardiac arrest was of 6.6% in the perindopril group and 8.0% in the placebo group leading to a relative risk reduction (RRR) with perindopril of 17.3%, [95% CI: 1.3%;30.8%] p=0.036. Incidence of myocardial infarction was of 4.6% for perindopril and 5.9% for placebo (RRR 23%, [95% CI: 4.9%;37.6%] p = 0.015).
In the 3047 revascularized patients without an history of MI, incidence of MI with perindopril was of 3.8% in the perindopril group as compared to 5.5% in the placebo group (RRR 31.7%, [95% CI: 4.4%;51.2%] p=0.026).
Conclusions: Perindopril 8 mg daily is beneficial for prevention of cardiac events in all stable CAD patients including those with previous revascularization and without previous MI.
Keywords: ACE inhibitor, Revascularization, Outcomes assessment