Is ramipril really better than other angiotensin-converting enzyme inhibitors after acute myocardial infarction?
Whether angiotensin-converting enzyme (ACE) inhibitors are interchangeable and equally efficacious after acute myocardial infarction (AMI) is controversial. We assessed whether ramipril was superior to other ACE inhibitors after AMI as suggested by a previously published study. We performed a retrospective cohort study using linked administrative databases on >1.4 million elderly residents in the province of Ontario who were admitted to the hospital for AMI, survived >or=30 days after discharge, and were initiated on an ACE inhibitor after AMI and remained on the same ACE inhibitor from April 1, 1997 to March 31, 2000. We followed patients for 2 years and measured readmission for AMI or mortality, together or alone. Our cohort included 5,408 elderly patients. Compared with patients on enalapril, there was no significant difference for the combined end points of readmission for AMI or mortality across users of ramipril (adjusted hazard ratio 0.95, 95% confidence interval 0.79 to 1.15),
Related Questions
- Is there a role for angiotensin-converting enzyme inhibitors in the treatment of chronic myocardial ischemia?
- Do ACE inhibitors provide protection for the heart in the clinical setting of acute myocardial infarction?
- Which patient benefits from early angiotensin-converting enzyme inhibition after myocardial infarction?
