Efficacy of Zofenopril Compared With Placebo and Other Angiotensin-converting Enzyme Inhibitors in Patients With Acute Myocardial Infarction and Previous Cardiovascular Risk Factors: A Pooled Individual Data Analysis of 4 Randomized, Double-blind, Controlled, Prospective Studies

Abstract

Abstract:In the Survival of Myocardial Infarction Long-term Evaluation (SMILE) 1, 3, and 4 studies, early administration of zofenopril in acute myocardial infarction showed to be prognostically beneficial versus placebo or ramipril. The SMILE-2 showed that both zofenopril and lisinopril are safe and showed no significant differences in the incidence of major cardiovascular (CV) complications. In this pooled analysis of individual data of the SMILE studies, we evaluated whether the superior efficacy of zofenopril is maintained also in patients with ≥1 CV risk factor (CV+, n = 2962) as compared to CV− (n = 668). The primary study end point was set to 1-year combined occurrence of death or hospitalization for CV causes. The risk of CV events was significantly reduced with zofenopril versus placebo either in the CV+ (−37%; hazard ratio: 0.63; 95% confidence interval: 0.51–0.78; P = 0.0001) or in the CV− group (−55%; hazard ratio: 0.45; 0.26–0.78; P = 0.004). Also, the other angiotensin-converting enzyme inhibitors reduced the risk of major CV outcomes, though the reduction was not statistically significant versus placebo (CV+: 0.78; 0.58–1.05; P = 0.107; CV−: 0.71; 0.36–1.41; P = 0.334). The benefit was larger in patients treated with zofenopril than other angiotensin-converting enzyme inhibitors, with a statistically significant difference for CV+ (0.79; 0.63–0.99; P = 0.039) versus CV− (0.62; 0.37–1.06; P = 0.081). In conclusion, zofenopril administered to patients after acute myocardial infarction has a positive impact on prognosis, regardless of the patient's CV risk profile.

Effect of Endostatin and Insulin-Like Growth Factor-1 on Angiogenesis in Patients With Acute Myocardial Infarction With Obesity Under the Influence of Zofenopril

“…The beneficial effect of zofenopril on angiogenesis was revealed: an increase in the level of IGF-1 in all categories of patients, as well as a decrease in endostatin in patients without obesity. Occurrence a higher survival rate was also registered in patients who took zofenopril since the AMI, which is consistent with the results of other studies [22,32].…”

“…As was shown in preclinical studies, zofenopril has cardioprotective properties and affects left ventricular remodeling in myocardial damage [21]. It is known that therapy with zofenopril may be an important support for ensuring a favorable prognosis for patients with a high risk of cardiovascular diseases after AMI [22].…”

The effect of milrinone on mortality in adult patients who underwent CABG surgery: a systematic review of randomized clinical trials with a meta-analysis and trial sequential analysis

“…Coronary artery disease (CAD) refers to the class of diseases of vascular stenosis or obstruction caused by coronary artery atherosclerotic lesions, resulting in myocardial ischemia, hypoxia or necrosis and including stable and unstable angina, myocardial infarction (MI), and sudden cardiac death [1]. Furthermore, CAD can cause serious complications due to multiple risk factors, such as a heart attack, damaged heart muscle, and an irregular heartbeat, and can result in sudden death [2][3][4] . At present, coronary artery bypass grafting (CABG) surgery is the primary strategy for CAD treatment [5][6][7][8][9].…”

The effect of milrinone on mortality in adult patients who underwent CABG surgery: A systematic review of randomized clinical trials with a meta-analysis and trial sequential analysis

“…Furthermore, CAD can cause serious complications due to multiple risk factors, such as a heart attack, damaged heart muscle, and an irregular heartbeat, and can result in sudden death. [3][4][5] At present, coronary artery bypass grafting (CABG) surgery is the primary strategy for CAD treatment. [6][7][8][9][10] CABG surgery is a surgical procedure in which vascular access between the root of the ascending aorta and the distal end of the lesion site is established to make blood bypass the coronary artery lesion site, flow to the distal end of the coronary artery stenosis or obstruction, and reach the ischemic myocardium, thus improving coronary perfusion and increasing myocardial oxygen supply.…”