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CLINICAL STUDIES

Effect of the angiotensin-converting enzyme inhibitor trandolapril on mortality and morbidity in diabetic patients with left ventricular dysfunction after acute myocardial infarction

^a Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Frederiksberg, Denmark
^* Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark

Manuscript received October 23, 1998; revised manuscript received February 3, 1999, accepted March 15, 1999.

Reprint requests and correspondence: Dr. Ida Gustafsson, Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark
gustafsson{at}dadlnet.dk

OBJECTIVES

This study evaluated the efficacy of long-term treatment with the angiotensin-converting enzyme (ACE) inhibitor trandolapril in diabetic patients with left ventricular dysfunction after acute myocardial infarction (AMI).

BACKGROUND

Patients with diabetes mellitus have a high mortality following AMI, probably due to a high risk of congestive heart failure and reinfarction. Because ACE inhibition effectively reduces progression of heart failure, it could be particularly beneficial in diabetic patients after AMI.

METHODS

The study is a retrospective analysis using data from the Trandolapril Cardiac Evaluation (TRACE) study, which was a randomized, double-blind, placebo-controlled trial of trandolapril in 1,749 patients with AMI and ejection fraction 35%. The mean follow-up time was 26 months.

RESULTS

A history of diabetes was found in 237 (14%) of the 1,749 patients. Treatment with trandolapril resulted in a relative risk (RR) of death from any cause for the diabetic group of 0.64 (95% confidence interval 0.45 to 0.91) versus 0.82 (0.69 to 0.97) for the nondiabetic group. In the diabetic group, trandolapril reduced the risk of progression to severe heart failure markedly (RR, 0.38 [0.21 to 0.67]), and no significant reduction of this end point was found in the nondiabetic group.

CONCLUSIONS

The ACE inhibition after myocardial infarction complicated by left ventricular dysfunction appears to be of considerable importance in patients with diabetes mellitus by saving lives and substantially reducing the risk of progression to severe heart failure.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   AIRE = Acute Ramipril Efficacy study   AMI = acute myocardial infarction   CI = confidence interval   GISSI-3 = Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico   RR = relative risk   SAVE = Survival and Ventricular Enlargement trial   TRACE = Trandolapril Cardiac Evaluation study   WMI = wall motion index

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