(Circulation. 1997;96:4239-4245.)
© 1997 American Heart Association, Inc.
Articles |
Effect of the ACE Inhibitor Lisinopril on Mortality in Diabetic Patients With Acute Myocardial Infarction
Data From the GISSI-3 Study
From the Istituto Mario Negri, Milano (G.Z., R.L., A.P.M., M.G.F, L.S., G.T.), and the Centro Studi ANMCO, Firenze (A.P.M.), Italy.
Correspondence to Giulio Zuanetti, MD, Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri, Via Eritrea, 62, 20157 Milano, Italy. E-mail zuanetti{at}irfmn.mnegri.it
Background Mortality of diabetic patients with acute myocardial infarction (MI) remains high despite recent improvement in their management. There is a need to evaluate efficacy and safety of novel treatments of MI in this high-risk population. We evaluated whether treatment with an ACE inhibitor begun within 24 hours from the onset of symptoms is able to decrease mortality and morbidity of diabetic patients with acute MI.
Methods and Results A retrospective analysis of the data
of the GISSI-3 study in patients with and without a history of diabetes
was performed. Patients with suspected acute MI were randomized to
treatment with lisinopril (2.5 to 5 up to 10 mg/d) with or
without nitroglycerin (5 to 20 µg IV then 10 mg/d)
begun within 24 hours and continued for 6 weeks. The main end point was
mortality at 6 weeks, and the secondary end point was a combined
evaluation of mortality and severe left ventricular
dysfunction. Information on diabetic status was available for 18 131
patients (
94% of the total population enrolled), of whom 2790
patients had a history of diabetes. Treatment with
lisinopril was associated with a decreased 6-week mortality
in diabetic patients (8.7% versus12.4%; OR, 0.68; 95% CI, 0.53 to
0.86; 37±12 lives saved per 1000 treated patients), an effect that was
significantly (P<.025) higher than that observed in
nondiabetic patients. The survival benefit in diabetics was mostly
maintained at 6 months despite withdrawal from treatment at 6 weeks
(12.9% versus 16.1%; OR, 0.77; 95% CI, 0.62 to 0.95).
Conclusions Early treatment with the ACE inhibitor lisinopril in diabetic patients with acute MI is associated with a decreased 6-week mortality. This beneficial effect supports a widespread and early use of ACE inhibitors in diabetic patients with acute MI. The burden of mortality plus morbidity for ventricular dysfunction in diabetics remains clinically important and warrants further testing of novel therapeutic approaches.
Key Words: myocardial infarction • lisinopril • mortality • diabetes mellitus
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