Chinese Cardiac Study - CCS-1


Captopril vs placebo after acute MI.


To dtermine if there is a mortality benefit of adding an ACE inhibitor within 36 hours of onset of acute MI in a broad group of patients.

Study Design

Study Design:

Patients Screened: Not reported
Patients Enrolled: 13634
NYHA Class: Not reported
Mean Follow Up: 4 weeks
Mean Patient Age: Not available (N/A)
Female: N/A
Mean Ejection Fraction: Not evaluated

Patient Populations:

patients with or without ST segment elevation presenting within 36 hours of symptom onset.


Persistent hypotension (SBP <90 mm Hg), chronic use of large doses of diuretics, and contraindications to ACE inhibitors.

Primary Endpoints:

4-week all-cause mortality

Secondary Endpoints:

hypotension, cardiogenic cshock, heart failure, ventricular fibrillation, other arrest, advanced heart block

Drug/Procedures Used:

Captopril 6.25 mg initial dose, 12.5 mg 2 hours later, then 12.5 mg three times daily; or placebo.

Principal Findings:

The captopril group sustained a mortality reduction at 4 weeks: 9.05% vs. 9.59% (p = 0.03). Captopril was associated with a significant excess of hypotension resulting a discontinuation of therapy (8.4% vs 4.9%) and higher incidence of peristent hypotension (16.3% vs 10,8%). In patients with an admission SBP <100 mmHg, 4 week mortality was slightly higher in captorpil group (11.0% vs 10.0%, p=NS). There was no difference in the rates of heart failure, ventricuylar fibrillation, advanced heart block, or other cardiac arrest.


The additive results of CCS-1, ISIS-4, CONSENSUS-II, GISSI-3, and 11 smaller trials show a clear benefit of ACE inhibitors: 6.5% odds reduction (7.27% vs. 7.73%; total of 100,963 patients).


Lancet 1995;345:686–67.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, SCD/Ventricular Arrhythmias, Acute Heart Failure

Keywords: Heart Block, Heart Failure, Coronary Disease, Hypotension, Heart Arrest, Captopril

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