1022-102 Mortality Results of the Trandolapril Cardiac Evaluation (TRACE) Trial

The aim of the TRAndolapril Cardiac Evaluation (TRACE) trial was to evaluate whether mortality of patients with left ventricular (LV) dysfunction shortly after myocardial infarction (MI) is reduced by long term treatment with an ACE-inhibitor, regardless of the presence of heart failure or ischemia.7001 consecutive enzyme confirmed Mis in 27 Danish hospitals were screened for entry into the study 2–6 days following MI. At screening 2dimensional echocardiography was recorded on videotape at the center and evaluated centrally. Wall motion index (WMI) was evaluated, and patients with WMI :≤1.2 (corresponding to left ventricular ejection fraction :≤0.35) were eligible for the study. Heart failure and ischemia did not exclude patients. After receiving a test dose. patients were randomly allocated to receive oral treatment with Trandolapril or placebo 3–7 days following the MI. The primary endpoint was all cause mortality (intention to treat). Follow up was a minimum of 2 years (range 2–4 years).Results2606 (37%) of the screened MIs had WMI :≤1.2. This represented a high risk group with an overall 1-year mortality of 34%. In contrast, patients with WMI>1.2 had a one year mortality of only 12%. Of patients eligible for the study based on LV function, 1749 patients (67%) were included.876 patients received Trandolapril and 873 patients Placebo. Baseline characteristics did not differ. Trandolapril caused a highly significant reduction in overall mortality. Overall risk reduction was 22%, p=0.0007. At study closure mortality of Trandolapril treated patients was 35% and that of placebo treated patients 42%.ConclusionLong term treatment with Trandolapril of patients with LV dysfunction shortly after MI, significantly reduced mortality. The study adds to the results of the SAVE trial by including a large proportion of eligible patients and not excluding patients with heart failure or ischemia