Long-term mortality in patients with myocardial infarction: impact of early treatment with captopril for 4 weeks
10.3760/j.issn:0366-6999.2001.02.001
- VernacularTitle:卡托普利或安慰剂对6749例心肌梗塞患者远期病死率的影响—中国心脏研究-Ⅰ(CCS-1)远期随访总结
- Author:
Lisheng LIU
1
Author Information
1. Fu Wai Hospital Chinese Academy of Medical Sciences (CAMS)
- Keywords:
captopril;
myocardial infarction;
long-term mortality
- From:
Chinese Medical Journal
2001;114(2):115-118
- CountryChina
- Language:Chinese
-
Abstract:
Objective In an earlier interim report of the Chinese Cardiac Study (CCS-1) trial, 15 000 patients up to 36 hours after the onset of suspected acute myocardial infarction (AMI) were randomized to receive either oral captopril or matching placebo for one month. Results showed that captopril was associated with a non-significant reduction in 4-week mortality (681 ［9.1%］ captopril-allocated vs 730 ［9.7%］ placebo-allocated deaths; 2P=0.19), but the long-term effects remained uncertain. The present study reports on the long-term effect of early captopril treatment on mortality and other major events in AMI patients of the earlier CCS-1 trial. Methods Long-term follow-up was carried out in those hospitals which had recruited more than 20 cases in the CCS-1 trial. 8000 patients with MI were thus selected for long-term follow-up. Data on 6749 patients (84.4%) were available. Results Patient characteristics were comparable between the treatment group (n=3391) and the placebo group (n=3358). Average follow-up time was 23.4±16.9 months; average age was 63.6±10.6 years, and 76.2% were male. At the end of the follow-up time, cardiac function of NYHA Ⅲ-Ⅳ was 9.0% in the treatment group and 9.8% in the placebo group; the reinfarction rate was 5.6% vs. 6.0%; total cardiovascular events were 32.9% vs. 34.3%. Total mortality was 11.9% (n=404) vs 13.8% (n=463), with a 13.8% reduction in the captopril group (P=0.03). Cardiovascular mortality was 10.0% vs. 11.8% (P=0.01), death due to heart failure was 4.1% vs. 5.5% (P=0.01). From the above results, it is estimated that early treatment with captopril can save 19 lives per 1000 patients treated; patients with systolic blood pressure (SBP)≥100 mm Hg at entry would have a long-term mortality 12.4% in the treatment group vs. 13.8% in the placebo group (P=0.04) and patients with a heart rate (HR)≥60/minute at entry would have a long term mortality 12.0% in captopril groups vs. 14.5% in the placebo group (P=0.01). Conclusion Early treatment with captopril during AMI for 4 weeks can significantly reduce long-term total mortality.
