The SAVE trial: Captopril after acute MI reduces mortality and morbidity [Classics Series]

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1. Treating patients with captopril after acute MI with asymptomatic LV dysfunction reduces mortality from cardiovascular causes (i.e., atherosclerotic heart disease, progressive heart failure).

2. The captopril group experienced lower rates of hospitalization due to heart failure and recurrent MI.

Study Rundown: The SAVE trial was the first to demonstrate that treating patients with acute MI and asymptomatic LV dysfunction with ACE-I reduces morbidity and mortality. These benefits are thought to result from ACE-Is slowing the remodeling process that takes place after patients suffer MIs. These findings have since been replicated in other trials (e.g., TRACE trial), systematic reviews, and meta-analyses.

In patients suffering from an acute MI and asymptomatic LV dysfunction, early initiation of and continued treatment with captopril can significantly reduce cardiovascular mortality, hospitalization due to heart failure, and recurrent MIs.

Please click to read the study in NEJM

In-Depth [randomized controlled study]: The SAVE trial, first published in 1992 in NEJM, is a randomized controlled trial that sought to explore the effect of captopril on mortality in patients suffering from acute myocardial infarction (MI) and asymptomatic left ventricular (LV) dysfunction. In previous animal studies, angiotensin converting enzyme inhibitors (ACE-Is) like captopril were shown to delay ventricular remodeling, and help preserve function after MI.

The trial was conducted at 45 centres across North America. A total of 2,231 patients took part in the study and were randomized to receive either captopril or placebo. Patients were followed for a minimum of 2 years, though mean follow-up was 42 months. Treatment with captopril or placebo was initiated 3-16 days after MI (mean of 11 days). Patients randomized to receive captopril experienced significantly reduced all-cause mortality and mortality from cardiovascular causes compared to the placebo group. Specifically, captopril was associated with significant reductions in mortality from atherosclerotic heart disease and progressive heart failure. Moreover, the captopril group demonstrated significant decreases in hospitalizations because of heart failure and recurrent MIs, compared to placebo.

By Adrienne Cheung, Andrew Cheung, M.D.

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