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Chinese Cardiac Study - CCS-1
Description:
Captopril vs placebo after acute MI.
Hypothesis:
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.
Exclusions:
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.
Interpretation:
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).
References:
Lancet 1995;345:686–67.
Keywords: Heart Block, Heart Failure, Coronary Disease, Hypotension, Heart Arrest, Captopril
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