The Effects of the Early Administration of Enalapril on Mortality in Patients with Acute myocardial infarction: Results of the Cooperative New Scandin - CONSENSUS II


Enalapril vs. placebo for 6-month mortality after acute MI.


Enalapril therapy started early post myocardial infarction improves 6 month survival.

Study Design

Study Design:

Patients Screened: Not given
Patients Enrolled: 6,090
NYHA Class: not measured
Mean Follow Up: 6 months
Mean Patient Age: 66
Female: 26
Mean Ejection Fraction: not measured

Patient Populations:

Acute myocardial infarction, presenting within 24 hours of chest pain onset.

Chest pain had to be associated with at least one of the following:
ST elevation in two or more contiguous leads
New, pathologic Q waves
Elevated cardiac enzymes


Blood pressure < 100/60 mmHg; this was subsequently changed to 105/65 mm Hg
Need for vasopressor
Hemodynamically significant valvular stenosis
3° AV block
Sensitivity to ACE inhibitor
Other significant co-morbidity
Clear indication for treatment with ACE inhibitor (i.e., congestive heart failure)

Primary Endpoints:

Mortality at 6 months following myocardial infarction

Secondary Endpoints:

Death in one month
Cause of death
Worsening heart failure

Drug/Procedures Used:

Enalaprilat initially (given parentally)
Enalapril (target dose 20 mg/day)

Concomitant Medications:

Nitrates (53%)
Beta blockers (66%)
Calcium Channel Blockers (24%)
Thrombolytic therapy (56%)

Principal Findings:

At six months, mortality was 11% in the Enalapril group and 9.9% of the placebo group.

Early hypotension occurred in 12% of the Enalapril group and 3% of placebo group (p < 0.001).

Results consistent across all subgroups.

A significant attenuation of LV dilatation was noted at 1 month in patients treated with enalapril compared with those receiving placebo. The between-group difference was most marked in patients with anterior wall infarction (p < 0.005). Volume changes beyond the first month were similar in both groups but the differences observed at 1 month were maintained.


No beneficial effect of intravenous enalaprilat followed by oral enalapril on mortality when administered within 24 hours post myocardial infarction. It is important to note in this study that follow-up was for 6 months only, possibly missing a late benefit due to ACE inhibitor therapy. The benefit of ACE inhibition appears most prominent for patients with anterior myocardial infarctions. This was a "non-selective" post myocardial infarction study without heart failure or left ventricular dysfunction on entry criterion. In ISIS-4 and GISSI-3, mortality improved by 0.46% and 0.8%, respectively, with risk reductions of 9% and 11%. In view of the risk of hypotension (20% in ISIS-4, compared with placebo 10%), very early ACE inhibition may benefit a highly selected subset of patients.


1. N Engl J Med 1992;327:678-684. Final results
2. Am J Cardiol 1993;72:1004-9. Echo findings

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Myocardial Infarction, Enalapril, Chest Pain, Risk Reduction Behavior, Heart Failure, Dilatation, Hypotension, Ventricular Dysfunction, Left

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