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PEACE study
A double blind, placebo controlled trial randomly assigned 8290 patients to receive either trandolapril at a target dose of 4 mg/day (4158 patients) or matching placebo (4132 patients).
Inclusion criteria were patients >50 years with coronary disease documented by angiography with >=1 (non-bypassed) lesion of >50% luminal diameter, or by prior myocardial infarction, coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty (>3 months), and ejection fraction >40%.
The trial tested the hypothesis that patients with stable coronary artery disease and normal or slightly reduced left ventricular function derive therapeutic benefit from the addition of ACE inhibitors to conventional therapy.
Introduction
In the post-myocardial infarction (MI) population, resting ejection fraction (EF) has been shown to be the single most important prognostic marker and an independent predictor of survival. 1-4 However, prognostic data in the subset of infarct survivors with preserved or mildly depressed EF are sparse.
In this context, it is also unclear whether one modality of EF measurement is superior to another in predicting survival. Resting left ventricular EF, as measured by transthoracic echocardiography (TTE), contrast ventriculography (CNV), and radionuclide angiography (RNA), exhibit high qualitative correlation; however, only modest agreement in quantitative value (% EF) exists between modalities. 5-9 Studies addressing this clinically relevant question have mostly been limited to the heart failure population. 4 10 11 Early clinical trials predominantly used RNA or CNV as the primary method for determining EF. 12 13 More recently, TTE has gained increasing popularity both in trials and routine clinical practice, due its wider availability and ability to provide supplemental information on chamber size, haemodynamics, and valvular function. 14-17 Nonetheless, each modality of EF measurement has its own advantages and limitations.
Therefore, the twin objectives of our study were to investigate whether (1) EF predicts mortality in a post-MI cohort with preserved or depressed EF, and (2) modality of EF assessment influences the ability to predict survival.
Methods
Study cohort
A retrospective analysis of the National Heart, Lung, and Blood Institute (NHLBI) limited access dataset of the multicentre Prevention of Events with Angiotensin Converting Enzyme Inhibition Trial (PEACE, 1996-2003, n=8290), comparing trandolapril versus placebo, was conducted. The design and composition of the PEACE trial has been described previously (see box). 17 18 Briefly, patients...