[Trandolapril in patients with left ventricular insufficiency after myocardial infarction].

The TRACE (TRAndolapril Cardiac Evaluation) study was designed to determine whether long-term treatment with an ACE inhibitor is beneficial in patients with early post-myocardial infarction cardiac failure. A total 6,676 consecutive patients with 7,001 myocardial infarctions were included; 2,606 patients had echocardiographic signes of left ventricular dysfunction (ejection fraction < 35%), 3 to 7 days after myocardial infarction; 1,749 patients were randomised and given either oral trandolapril (876 patients) or placebo (873 patients). Follow-up ranged from 24 to 50 months. Three hundred and four patients (34.7%) in the trandolapril group died, compared with 369 (42.3%) in the placebo group (p = 0.001). The relative risk of death in the trandolapril group compared with the placebo group was 0.78. Trandolapril was also associated with a statistically significantly lower risk of cardiovascular death and of sudden death. Progression to severe cardiac failure was also less frequent in the treatment group. On the other hand, the risk of recurrent myocardial infarction was not significantly reduced. In conclusion, long-term treatment with trandolapril in patients with early post-infarction left ventricular dysfunction significantly reduced the risk of cardiovascular mortality, sudden death and progression to severe cardiac failure.