Angiotensin - converting enzyme inhibition with perindopril in patients with prior myocardial infarction and/or revascularization: A subgroup analysis of the EUROPA trial

Background.— The European trial on Reduction Of cardiac events with perindopril in patients with stable coronary Artery disease (EUROPA) demonstrated the benefits of perindopril with respect to secondary prevention of cardiovascular risk in patients with stable coronary artery disease. Aims.— To describe the clinical effects of perindopril in a subpopulation of patients from EUROPA with a history of myocardial infarction and/or revascularization. Patients and methods.— Of the 12,218 patients in the EUROPA study, 10,962 had a history of myocardial infarction and/or revascularization. In this EUROPA subpopulation, 7910 patients had a history of myocardial infarction and 6709 had a history of revascularization. Patients were randomized to treatment with perindopril 8 mg/day or placebo. The primary endpoint was a composite of cardiovascular mortality, myocardial infarction and resuscitated cardiac arrest. Results.— After a mean follow-up of 4.2 years, treatment with perindopril 8 mg/day was associated with a 22.4% reduction in the primary endpoint compared with placebo (p < 0.001) in patients with a history of myocardial infarction. Patients with a history of myocardial revascularization showed a 17.3% reduction in the primary endpoint with perindopril versus placebo (p < 0.05). In the combined population of patients with a history of myocardial infarction and/or revascularization, treatment with perindopril produced a 22.4% reduction in the primary endpoint compared with placebo (p < 0.001). Conclusions.— This study confirms the benefits of a high dose of angiotensin-converting enzyme inhibitor for the secondary prevention of cardiovascular risk among patients with a history of myocardial infarction and/or revascularization. © 2008 Elsevier Masson SAS. All rights reserved