The Effects Of Angiotensin-converting Enzyme Inhibitors On Mortality And Cardiovascular Events In Patients With Coronary Artery Disease And Without Left Ventricular Systolic Dysfunction: A Meta-analysis

Objective: Results of randomized trials of ACEIs in patients with CAD and preserved left ventricular function are conflicting. We perform this meta-analysis to determine whether long-term use of ACEIs decreases major cardiovascular events and mortality in patients with CAD and without left ventricular systolic dysfunction.Methods: We searched MEDLINE, EMBASE, and IPA databases. Search terms included angiotensin-converting enzyme inhibitors,coronary artery disease, randomi(s)zed controlled trials, clinical trials, and myocardial infarction.Eligible studies included randomized controlled trials in patients with CAD and without heart failure or left ventricular dysfunction, with follow-up of 2 years or longer. Of 1146 publications screened, 7 met our selection criteria including HOPE, PART-2, EUROPA, QUIET, PEACE, CAMELOT and IMAGINE, with a total of 36053 patients.Results: Treatment with ACEIs decreased overall mortality (OR 0.86; 95%CI 0.80-0.94), cardiovascular mortality (OR 0.82; 95%CI 0.74-0.91), myocardial infarction (OR 0.85; 95%CI 0.76-0.95), and stroke or TIA (OR 0.78; 95%CI 0.66-0.91). Other end points, including resuscitation after cardiac arrest, myocardial revascularization, and hospitalization due to heart failure, were also reduced.Conclusion: ACEIs reduce total mortality and major cardiovascular end points in patients with CAD and without left ventricular dysfunction.