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Clinical effects of early angiotensin-converting enzyme inhibitor treatment for acute myocardial infarction are similar in the presence and absence of aspirin

Systematic overview of individual data from 96,712 randomized patients

Roberto Latini, MD^*, Gianni Tognoni, MD^*, Aldo P. Maggioni, MD^* , Colin Baigent, MB, BCh, Eugene Braunwald, MD, Zheng-Ming Chen, PhD, Rory Collins, MB, BS, Marcus Flather, MD^||, MariaGrazia Franzosi, PhD^*, John Kjekshus, MD^¶, Lars Køber, MD^#, Li-Sheng Liu, MD^**, Richard Peto, FRS, Marc Pfeffer, MD, Fabrizio Pizzetti, MD, Eugenio Santoro, MSc^*, Peter Sleight, MD, Karl Swedberg, MD, Luigi Tavazzi, MD, Wen Wang, MSc^**, Salim Yusuf, MD^|||| on behalf of the Angiotensin-converting Enzyme Inhibitor Myocardial Infarction Collaborative Group¹

^* Istituto di Ricerche Farmacologiche "Mario Negri," Milano, Italy
Associazione Nazionale Medici-Cardiologi Ospedalieri, Firenze, Italy
Clinical Trial Service Unit, Radcliffe Infirmary, Oxford, United Kingdom
Brigham and Women’s Hospital, Boston, Massachusetts, USA
^|| Royal Brompton Hospital, London, United Kingdom
^¶ The National Hospital, University of Oslo, Oslo, Norway
^# Gentofte Hospital/University of Copenhagen, Hellerup, Denmark
^** Fu Wai Hospital, Beijing, China
Santo Spirito Hospital, Casale Monferrato (AL), Italy
Göteborg University, Göteborg, Sweden
Policlinico S. Matteo, Pavia, Italy
^|||| McMaster Clinic, Hamilton General Hospital, Hamilton, Ontario, Canada

View larger version (24K): [in a new window]   Figure 1 Proportional effect of ACEi therapy on 30-day mortality in the presence and absence of concomitant ASA. The odds ratio for each trial is represented by a square (area proportional to number of patients with an event), with 99% CI (horizontal line). The overall results for the trials and their 95% CI are represented by diamonds. ACEi = angiotensin-converting enzyme inhibitor; ASA = aspirin; CI = confidence intervals.

View larger version (17K): [in a new window]   Figure 2 Randomized comparison of ACEi versus no-ACEi on 30-day mortality in (poor-average prognosis) patients who were not given ASA and in (good-average prognosis) patients who were given ASA. Note that although ASA must have been responsible for some benefit, differences in prognosis between patients may well be responsible for more than half of the difference in outcome between ASA and no-ASA in this Figure.

View larger version (18K): [in a new window]   Figure 3 (A) Effects of ACEi therapy on 30-day incidence of persistent hypotension and renal dysfunction in the presence and absence of concomitant ASA. (B) Effects of ACEi therapy on 30-day incidence of heart failure, reinfarction and stroke in the presence and absence of concomitant ASA. *Percentages for heart failure are of patients surviving at day 30; **CONSENSUS-II patients are excluded from this analysis because data on stroke were not available.