EvidenceAlerts 01/2021
Wu J, Hall AS, Gale CP Long-term survival benefit of ramipril in patients with acute myocardial infarction complicated by heart failure. Heart. 2021 Jan 15. pii: heartjnl-2020-316823. doi: 10.1136/heartjnl-2020-316823. (Original study)
Abstract von Evidence Alerts
AIMS: ACE inhibition reduces mortality and morbidity in patients with heart failure after acute myocardial infarction (AMI). However, there are limited randomised data about the long-term survival benefits of ACE inhibition in this population.
METHODS: In 1993, the Acute Infarction Ramipril ETcacy (AIRE) study randomly allocated patients with AMI and clinical heart failure to ramipril or placebo. The duration of masked trial therapy in the UK cohort (603 patients, mean age=64.7 years, 455 male patients) was 12.4 and 13.4 months for ramipril (n=302) and placebo (n=301), respectively. We estimated life expectancy and extensions of life (difference in median survival times) according to duration of follow-up (range 0-29.6 years).
RESULTS: By 9 April 2019, death from all causes occurred in 266 (88.4%) patients in placebo arm and 275 (91.1%) patients in ramipril arm. The extension of life between ramipril and placebo groups was 14.5 months (95% CI 13.2 to 15.8). Ramipril increased life expectancy more for patients with than without diabetes (life expectancy difference 32.1 vs 5.0 months), previous AMI (20.1 vs 4.9 months), previous heart failure (19.5 vs 4.9 months), hypertension (16.6 vs 8.3 months), angina (16.2 vs 5.0 months) and age >65 years (11.3 vs 5.7 months). Given potential treatment switching, the true absolute treatment effect could be underestimated by 28%.
CONCLUSION: For patients with clinically defined heart failure following AMI, ramipril results in a sustained survival benefit, and is associated with an extension of life of up to 14.5 months for, on average, 13 months treatment duration.
Fazit:
Nach einem Jahr die Indikation für ACE-Hemmer und ß-Blocker überprüfen. Dann Absetzen nach Möglichkeit.
Fazit Regen:
In der Regel werden ACE-Hemmer für den gleichzeitig bestehenden Hypertonus gegeben. Hier würden wir es ja nicht als Sekundärprophylaxe einsetzen sondern als Hypertonie-Therapeutikum.
Trotzdem sollte man die Indikation gut überprüfen.