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The effect of angiotensin-converting enzyme inhibitors on clinical outcomes in patients with ischemic cardiomyopathy and midrange ejection fraction: a post hoc subgroup analysis from the PEACE trial.

Authors
  • Alzahrani, Talal1
  • Tiu, John2
  • Panjrath, Gurusher2
  • Solomon, Allen2
  • 1 Division of Cardiology, Department of Medicine, George Washington University, 2150 Pennsylvania Ave NW, Fourth Floor, Washington, DC, 20037, USA.
  • 2 Division of Cardiology, Department of Medicine, George Washington University, Washington, DC, USA.
Type
Published Article
Journal
Therapeutic advances in cardiovascular disease
Publication Date
Dec 01, 2018
Volume
12
Issue
12
Pages
351–359
Identifiers
DOI: 10.1177/1753944718809266
PMID: 30442080
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

There have been significant advances in the treatment of patients with cardiomyopathy with reduced ejection fraction (EF < 40%). However, there is a dearth of information in the treatment of patients with cardiomyopathy and midrange EF (40-50%). Current guidelines state to treat these patients similarly to patients with cardiomyopathy and preserved EF. Data from the Prevention of Events with Angiotensin-Converting Enzyme Inhibition (PEACE) trial were used to elucidate whether angiotensin-converting enzyme (ACE) inhibitors improve clinical outcomes in patients with ischemic cardiomyopathy and midrange EF. A post hoc subgroup analysis of the PEACE trial was conducted to evaluate the effect of ACE inhibitors in a subgroup of patients with ischemic cardiomyopathy and midrange EF (40-50%). A Chi-square test and a Student's t-test were used to examine and compare the binary and continuous variables of baseline characteristics and outcomes between experimental and comparison groups. We studied a subgroup of patients from the PEACE trial with ischemic cardiomyopathy and midrange EF ( n = 2512 of 8290 total patients). Patients were assigned to either the interventional group ( n = 1247) or the placebo group ( n = 1265). There were no significant differences in baseline demographic and health characteristics between the two groups. During a total of 7 years (mean 4.7 years) of follow up, the risk of composite outcomes [all-cause mortality, nonfatal myocardial infarction, and stroke; relative risk (RR) 0.79, 95% confidence interval (CI) 0.63-0.98; p = 0.03] and all-cause mortality (RR 0.85, 95% CI 0.73-0.99; p = 0.03) was reduced in patients treated with trandolapril. This study revealed the benefit of ACE inhibitors among patients with ischemic cardiomyopathy and midrange EF.

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