Trace

Echocardiography was used to select patients participating in the Trandolapril Cardiac Evaluation (TRACE) trial (40). Patients were screened within 2-6 d and wall motion index was calculated based on the nine-segment wall motion assessment described by Heger et al. (41), and calculated to select patients with EFs of <35%. In TRACE, approx 39% of all MI patients had an early EF of <35%. There was a significant 22% reduction in mortality after 24-50 mo in patients with LV dysfunction assigned at random to trandolapril 1 mg orally once daily, slowly titrated to 4 mg once daily. As in the other trials, those patients treated with the ACE inhibitor had improved survival (Fig. 4A) and a lower incidence of heart failure (Fig. 4B).

Fig. 4. (A) Cumulative mortality from all causes among patients receiving trandolapril or placebo. Mortality curves diverged early, with estimated mortality at 1 mo of 8.8% in the trandolapril group and 11.2% in the placebo group. The relative risk of death from any cause in the trandolapril group, compared with the placebo group, was 0.78 (95% CI: 0.67-0.91; p = 0.001). (B) Progression to severe heart failure occurred more often and developed earlier in the placebo group compared with the trandolapril group (relative risk, 0.71; 95% CI: 0.56-0.89;p = 0.001). Data from ref. 40.

Fig. 4. (A) Cumulative mortality from all causes among patients receiving trandolapril or placebo. Mortality curves diverged early, with estimated mortality at 1 mo of 8.8% in the trandolapril group and 11.2% in the placebo group. The relative risk of death from any cause in the trandolapril group, compared with the placebo group, was 0.78 (95% CI: 0.67-0.91; p = 0.001). (B) Progression to severe heart failure occurred more often and developed earlier in the placebo group compared with the trandolapril group (relative risk, 0.71; 95% CI: 0.56-0.89;p = 0.001). Data from ref. 40.

Fig. 5. Estimates of the composite outcome of MI, stroke, or death from cardiovascular causes in the ramipril group and the placebo group. The relative risk of the composite outcome in the ramipril group as compared with the placebo group was 0.78 (95% CI:, 0.70-0.86). Data from ref. 43.

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