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Impact of ramipril versus other angiotensin-converting enzyme inhibitors on outcome of unselected patients with ST-elevation acute myocardial infarction

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Abstract

We examined the impact of treatment with ramipril versus other angiotensin-converting enzyme (ACE) inhibitors on clinical outcome in unselected patients of the prospective multicenter registry Maximal Individual Therapy of Acute Myocardial Infarction PLUS registry (MITRA PLUS). Of 14,608 consecutive patients with ST-elevation acute myocardial infarction, 4.7% received acute therapy with ramipril, 39.0% received other ACE inhibitor therapy, and 56.3% received no ACE inhibitor therapy. In a multivariate analysis, the treatment with ramipril compared with the treatment without ACE inhibitors was associated with a significantly lower hospital mortality and a lower rate of nonfatal major adverse coronary and cerebrovascular events. Compared with other generic ACE inhibitors, ramipril therapy was independently associated with a significantly lower hospital mortality (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.32 to 0.90) and a lower rate of nonfatal major adverse coronary and cerebrovascular events (OR 0.65, 95% CI 0.46 to 0.93), but not with a lower rate of heart failure at discharge (OR 0.79, 95% CI 0.50 to 1.27).

Section snippets

Methods

The Maximal Individual Therapy of Acute Myocardial Infarction PLUS registry (MITRA PLUS) is a German prospective, multicenter, observational data pool of current treatment of AMI. From 1992 to 2002, 53,853 consecutive patients were included in the MITRA PLUS registry. The MITRA PLUS registry consists of 3 consecutive subregistries that have been previously described: 60 minutes Myocardial Infarction Project (60 minutes MIP),13 Maximal Individual Therapy in Acute Myocardial Infarction (MITRA),14

Results

Of the consecutive 14,608 patients with ST-elevation AMI, 685 patients (4.7%) received ramipril therapy, 5,696 patients (39.0%) received other ACE inhibitor therapy, and 8,227 patients (56.3%) received no ACE inhibitor therapy. Of the patients receiving acute ramipril therapy, 89% were still on ramipril therapy at discharge.

Discussion

We investigated the impact of ramipril treatment versus other ACE inhibitor treatment on outcome in unselected patients with AMI in the prospective multicenter MITRA PLUS registry. In a multivariate analysis, acute ramipril therapy was associated with a significantly lower hospital mortality and a lower rate of major adverse coronary and cerebrovascular events compared with the patients who did not receive any ACE inhibitors. This benefit of ramipril therapy compared with therapy without any

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This study was supported in part by Aventis Pharma, Bad Soden, Germany; MSD, München, Germany; AstraZeneca, Wedel, Germany; Bristol-Myers Squibb, München, Germany; Knoll AG, Ludwigshafen, Germany; the Landesversicherungsanstalt, Rheinland-Pfalz, Germany; and the Ministerium für Arbeit, Soziales und Gesundheit, Rheinland-Pfalz, Germany.

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