14289
document
Effect of enalapril on myocardial infarction and unstable angina in patients with low ejection fractions . An association between raised renin levels and myocardial infarction has been reported . We studied the effects of enalapril , an angiotensin-converting enzyme ( ACE ) inhibitor , on the development of myocardial infarction and unstable angina in 6797 patients with ejection fractions < or = 0.35 enrolled into the two Studies of Left Ventricular Dysfunction ( SOLVD ) trials . Patients were randomly assigned to placebo ( n = 3401 ) or enalapril ( n = 3396 ) at doses of 2.5-20 mg per day in two concurrent double-blind trials with the same protocol . Patients with heart failure entered the treatment trial ( n = 2569 ) and those without heart failure entered the prevention trial ( n = 4228 ) . Follow-up averaged 40 months . In each trial there were significant reductions in the number of patients developing myocardial infarction ( treatment trial : 158 placebo vs 127 enalapril , p < 0.02 ; prevention trial : 204 vs 161 p < 0.01 ) or unstable angina ( 240 vs 187 p < 0.001 ; 355 vs 312 , p < 0.05 ) . Combined , there were 362 placebo group patients with myocardial infarction compared with 288 in the enalapril group ( risk reduction 23 % , 95 % CI 11-34 % ; p < 0.001 ) . 595 placebo group patients developed unstable angina compared with 499 in the enalapril group ( risk reduction 20 % , 95 % CI 9-29 % , p < 0.001 ) . There was also a reduction in cardiac deaths ( 711 placebo , 615 enalapril ; p < 0.003 ) , so that the reduction in the combined endpoint of deaths , myocardial infarction , and unstable angina was highly significant ( 20 % risk reduction , 95 % CI 14-26 % ; p < 0.0001 ) . Enalapril treatment significantly reduced myocardial infarction , unstable angina , and cardiac mortality in patients with low ejection fractions .
14290
Intervention_Pharmacological
enalapril
14291
Intervention_Pharmacological
enalapril
14292
Intervention_Control
placebo
14293
Intervention_Pharmacological
enalapril
14294
Intervention_Control
placebo
14295
Intervention_Pharmacological
enalapril
14296
Intervention_Control
placebo
14297
Intervention_Pharmacological
enalapril
14298
Intervention_Control
placebo
14299
Intervention_Pharmacological
enalapril
14300
Intervention_Control
placebo
14301
Intervention_Pharmacological
enalapril
14302
Intervention_Control
Enalapril
14303
Outcome_Physical
unstable angina
14304
Outcome_Physical
reduction in cardiac deaths
14305
Outcome_Mortality
deaths
14306
Outcome_Physical
myocardial infarction
14307
Outcome_Physical
unstable angina
14308
Outcome_Physical
myocardial infarction
14309
Outcome_Physical
unstable angina
14310
Outcome_Mortality
cardiac mortality
14311
Participant_Condition
patients with low ejection fractions
14312
Participant_Sample-size
6797
14313
Participant_Condition
with ejection fractions < or = 0.35 enrolled into the two Studies of Left Ventricular Dysfunction ( SOLVD ) trials
14314
Participant_Sample-size
2569
14315
Participant_Sample-size
4228
14316
Participant_Sample-size
362
14317
Participant_Sample-size
595