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AIRE: Acute Infarction Ramipril Efficacy study

AIRE: Acute Infarction Ramipril Efficacy study. Purpose To determine whether the ACE inhibitor ramipril reduces mortality in patients with evidence of heart failure after MI Reference

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AIRE: Acute Infarction Ramipril Efficacy study

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  1. AIRE: Acute Infarction Ramipril Efficacy study Purpose To determine whether the ACE inhibitor ramipril reduces mortality in patients with evidence of heart failure after MI Reference The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993;342:821–8.

  2. AIRE: Acute Infarction Ramipril Efficacy study - TRIAL DESIGN - Design Multicenter, multinational, randomized, double-blind, placebo-controlled Patients 2006 patients, aged >18 years, with evidence of heart failure 3–10 days after MI; patients with severe heart failure (usually NYHA class IV) or ongoing ischemia excluded Follow up and primary endpoint Average 15 months follow up. Primary endpoint all-cause mortality Treatment Placebo or ramipril initiated at 2.5 mg twice daily; increased to 5 mg twice daily after 2 days if tolerated

  3. AIRE: Acute Infarction Ramipril Efficacy study- RESULTS - • Significant reduction in all-cause mortality in ramipril group compared with placebo (17 vs. 23%, relative risk reduction 23%, P=0.002) • Reduction in mortality apparent as early as 30 days and consistent across a wide range of subgroups • Fewer patients in ramipril group developed severe/resistant heart failure • No significant reduction in reinfarction or stroke • Drug well tolerated, as defined by withdrawal rate from trial: only marginally higher with ramipril

  4. AIRE: Acute Infarction Ramipril Efficacy study- RESULTS continued- All-cause mortality Cumulative 35 Placebo mortality 30 (%) Ramipril 25 20 15 10 Relative hazard 0.73 (95% CI 0.60 – 0.89) 5 P=0.002 0 0 6 12 18 24 30 Months after randomization No. at risk Ramipril 1004 889 592 290 123 45 Placebo 982 845 575 287 98 44 AIRE Study Investigators. Lancet 1993; 342 :821 – 8.

  5. AIRE: Acute Infarction Ramipril Efficacy study- RESULTS continued- Effect of ramipril on subgroups Favors Favors Favors Favors ramipril placebo ramipril placebo Age: Hypertension: <65 years No >65 years Yes Sex: Thrombolysis: Male No Female Yes MI to Aspirin: <5 days No randomization: >5 days Yes Angina: Beta-blocker: No No Yes Yes Relative hazard Relative hazard 0.4 0.6 0.8 1 1.4 0.4 0.6 0.8 1 1.4 1.2 1.6 1.2 1.6 AIRE Study Investigators. Lancet 1993; 342 :821 – 8.

  6. Placebo Ramipril (n=982) (n=1004) No. (%) No. (%) 222 (23) 170 (17) 178 (18) 143 (14) 88 (9) 81 (8) 17 (2) 25 (2) AIRE: Acute Infarction Ramipril Efficacy study- RESULTS continued- Primary and secondary outcomes Primary endpoint Death Secondary events validated by outcomes subcommittee Severe/resistant heart failure Reinfarction Stroke AIRE Study Investigators. Lancet 1993; 342 :821 – 8.

  7. AIRE: Acute Infarction Ramipril Efficacy study - SUMMARY - In patients with non-severe heart failure after MI, ramipril commenced 3–10 days after MI and continued for a mean 15-month period: • Significantly reduced all-cause mortality • Conferred benefit independent of age, sex, hypertension, angina or concomitant therapy

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