Aims: To investigate the long- term benefits of treatment with angiotensin- converting enzyme(ACE)- inhibitors in patients with myocardial infarction(MI) and left ventricular dysfunction(LVD).Methods and results: In t...Aims: To investigate the long- term benefits of treatment with angiotensin- converting enzyme(ACE)- inhibitors in patients with myocardial infarction(MI) and left ventricular dysfunction(LVD).Methods and results: In the trandolapril cardiac evaluation(TRACE) study, 1749 patients with LVD(ejection fraction≤ 35% ) were randomized to trandolapril(n=876) or placebo(n=873) 3- 7 days post- MI. Enrolment lasted from 1990 to 1994; on- treatment follow- up ranged from 2 to 4 years. At study closure, all patients were recommended continued ACE inhibitor use. National registries were used to track deaths and hospitalizations until 2002. Mortality was analysed with Cox proportional hazard models and hospitalization with Poisson regression models(models adjusted for observation time). Over 10- 12 years of follow- up, a total of 1283 deaths and 9220 hospitalizations were registered. Compared with the placebo group, the trandolapril group had a significantly reduced risk of all- cause mortality(relative risk 0.89, 95% CI 0.80- 0.99, P=0.03), all- cause hospitalizations(rate ratio 0.92, 95% CI 0.88- 0.96, P< 0.001), and cardiovascular hospitalizations(rate ratio 0.95, 95% CI 0.91- 1.00, P=0.047), including congestive heart failure hospitalizations(rate ratio 0.85, 95% CI 0.77- 0.93, P< 0.001). Conclusion: In patients with LVD, use of trandolapril shortly after an MI for 2- 4 years has long- term benefits. The beneficial effect on mortality and hospitalization rates is maintained for at least 10- 12 years.展开更多
To analyse the effect of the change in diagnostic criteria for acute myocardial infarction(AMI) and the use of troponin as a diagnostic marker on the hospitalization rate and mortality of hospitalized AMI patients fro...To analyse the effect of the change in diagnostic criteria for acute myocardial infarction(AMI) and the use of troponin as a diagnostic marker on the hospitalization rate and mortality of hospitalized AMI patients from 1994 to 2001. Methods and results: Patients(≥ 30 years) admitted for their first AMI were identified using the National Patient Registry in Denmark. We registered when each hospital introduced troponin as a diagnostic marker. The reported hospitalization rate decreased until 1998 and then increased substantially from 1999 to 2001 from 3472 to 4163 per million inhabitants(19.9% ) for men and from 1648 to 2020 per million inhabitants(22.6% ) for women. Troponin use was associated with a significant 14% increase in hospitalization rate in this period[rate ratio 1.14, 95% confidence interval(CI) 1.11- 1.18]. The effect of troponin was greatest among patients 70 years and older(rate ratio 1.19, 95% CI 1.14- 1.23). The 28 day mortality decreased steadily from 25.9% in 1994 to 17.5% in 2002(32.4% ) and was not affected by troponin use. Conclusion: The reported hospitalization rate for AMI increased significantly after the new diagnostic criteria for AMI were introduced. The measurement of cardiac troponins further increased the hospitalization rate. The mortality among hospitalized patients with AMI declined steadily and was not affected by the use of troponins.展开更多
文摘Aims: To investigate the long- term benefits of treatment with angiotensin- converting enzyme(ACE)- inhibitors in patients with myocardial infarction(MI) and left ventricular dysfunction(LVD).Methods and results: In the trandolapril cardiac evaluation(TRACE) study, 1749 patients with LVD(ejection fraction≤ 35% ) were randomized to trandolapril(n=876) or placebo(n=873) 3- 7 days post- MI. Enrolment lasted from 1990 to 1994; on- treatment follow- up ranged from 2 to 4 years. At study closure, all patients were recommended continued ACE inhibitor use. National registries were used to track deaths and hospitalizations until 2002. Mortality was analysed with Cox proportional hazard models and hospitalization with Poisson regression models(models adjusted for observation time). Over 10- 12 years of follow- up, a total of 1283 deaths and 9220 hospitalizations were registered. Compared with the placebo group, the trandolapril group had a significantly reduced risk of all- cause mortality(relative risk 0.89, 95% CI 0.80- 0.99, P=0.03), all- cause hospitalizations(rate ratio 0.92, 95% CI 0.88- 0.96, P< 0.001), and cardiovascular hospitalizations(rate ratio 0.95, 95% CI 0.91- 1.00, P=0.047), including congestive heart failure hospitalizations(rate ratio 0.85, 95% CI 0.77- 0.93, P< 0.001). Conclusion: In patients with LVD, use of trandolapril shortly after an MI for 2- 4 years has long- term benefits. The beneficial effect on mortality and hospitalization rates is maintained for at least 10- 12 years.
文摘To analyse the effect of the change in diagnostic criteria for acute myocardial infarction(AMI) and the use of troponin as a diagnostic marker on the hospitalization rate and mortality of hospitalized AMI patients from 1994 to 2001. Methods and results: Patients(≥ 30 years) admitted for their first AMI were identified using the National Patient Registry in Denmark. We registered when each hospital introduced troponin as a diagnostic marker. The reported hospitalization rate decreased until 1998 and then increased substantially from 1999 to 2001 from 3472 to 4163 per million inhabitants(19.9% ) for men and from 1648 to 2020 per million inhabitants(22.6% ) for women. Troponin use was associated with a significant 14% increase in hospitalization rate in this period[rate ratio 1.14, 95% confidence interval(CI) 1.11- 1.18]. The effect of troponin was greatest among patients 70 years and older(rate ratio 1.19, 95% CI 1.14- 1.23). The 28 day mortality decreased steadily from 25.9% in 1994 to 17.5% in 2002(32.4% ) and was not affected by troponin use. Conclusion: The reported hospitalization rate for AMI increased significantly after the new diagnostic criteria for AMI were introduced. The measurement of cardiac troponins further increased the hospitalization rate. The mortality among hospitalized patients with AMI declined steadily and was not affected by the use of troponins.
