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CARDIOLOGY
UPDATE - Landmark Trials
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MITRA PLUS
Maximal Individual Therapy of
Acute Myocardial Infarction PLUS |
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Aim
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To analyze if ramipril treatment has a beneficial effect on mortality and cardiovascular events in the setting of acute myocardial infarction (AMI) in clinical practice.
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To examine whether ramipril treatment is associated with a better outcome than other ACE inhibitors.
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Methods
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The study analysed prespecified, consecutive patients with ST elevation AMI registered in the German observational data pool, MITRA Plus (Maximal Individual Therapy of Acute Myocardial Infarction PLUS) registry from 1996 to 1998.
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Patient number
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14,608
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Treatment groups
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| Groups |
Therapy |
Percentage of patients |
Group I |
Ramipril |
4.7% |
Group II |
Other ACE inhibitors |
39.0% |
Group III |
No ACE inhibitor |
56.3% |
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Patient characteristics
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Patients with ST-elevation AMI presenting within the first 96 hours after onset of pain.
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Clinical outcomes
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Hospital mortality and nonfatal coronary/cerebrovascular events [Stroke, reinfarction, emergency angioplasty/bypass surgery and resuscitation (>48 hours)].
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Results
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Compared to other ACE inhibitors, ramipril was associated with significantly lower hospital mortality. In patients receiving no ACE inhibitor treatment, it was more than twice as high as in patients receiving ramipril treatment.
| Major Adverse Coronary and Cerebrovascular Events |
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Ramipril
(n = 685) |
Other ACE Inhibitor
(n = 5,696) |
No ACE Inhibitor
(n = 8,227) |
p Value |
| Heart failure at discharge |
5.6% |
6.0% |
4.2% |
<0.05 |
| Nonfatal major coronary/cerebrovascular events |
9.2% |
11.6% |
14.1% |
<0.05 |
| Stroke |
0.3% |
0.7% |
1.2% |
<0.05 |
| Emergency PTCA/CABG |
6.6% |
8.8% |
10.3% |
<0.05 |
| CABG = coronary artery bypass grafting; PTCA = percutaneous transuminal coronary angioplasty. |
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Beneficial effect of ramipril was evident in all subgroups including patients with or without diabetes, hypertension, previous myocardial infarction or heart failure on admission and those with or without beta-blocker or reperfusion therapy.
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Conclusion
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Acute therapy with ramipril in clinical practice was associated with a reduction in mortality and coronary and cerebrovascular events in patients with ST-elevation AMI.
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“Ramipril treatment has a more beneficial effect on cardiovascular events than treatment with other ACE inhibitors.” |
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Bibliography :
1. N Engl J Med 2000; 342:145-153
2. Clin Cardiol 1991;14737-742
3. J Hum Hypertens 1999; 13:47 -53
4. Lancet 1997;349: 1857-1863
5. Lancet 1997;349:1493-1497
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