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OPTIMAAL: Optimal Trial In Myocardial Infarction with the Angiotensin Antagonist Losartan

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OPTIMAAL: Optimal Trial In Myocardial Infarction with the Angiotensin Antagonist Losartan

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    1. OPTIMAAL: Optimal Trial In Myocardial Infarction with the Angiotensin Antagonist Losartan Purpose To determine whether the angiotensin II receptor blocker losartan is superior or inferior to the angiotensin converting enzyme (ACE) inhibitor captopril in reduction of all-cause mortality in high-risk patients after acute MI Reference Dickstein K, Kjekshus J and the OPTIMAAL Steering Committee, for the OPTIMAAL Study Group. Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. Lancet 2002;360:752–60.

    2. OPTIMAAL: Optimal Trial In Myocardial Infarction with the Angiotensin Antagonist Losartan - TRIAL DESIGN - Design Multicenter, multinational, randomized, double-blind, parallel-group Patients 5466 patients aged >50 years with acute MI and evidence of heart failure or left ventricular dysfunction (left ventricular ejection fraction <35%) Follow up and primary endpoint Primary endpoint: all-cause mortality. Mean 2.7 years follow up Treatment Captopril (titrated to target dose 50 mg three times daily, as tolerated) or losartan (titrated to target 50 mg daily, as tolerated)

    3. OPTIMAAL: Optimal Trial In Myocardial Infarction with the Angiotensin Antagonist Losartan - TRIAL DESIGN continued-

    4. OPTIMAAL: Optimal Trial In Myocardial Infarction with the Angiotensin Antagonist Losartan - RESULTS - All-cause mortality nonsignificantly higher in losartan group compared with captopril (18.2 vs. 16.4%, P=0.069) Mortality curves separated early on and then largely remained parallel Nonsignificant difference in favor of captopril in: Sudden cardiac death or resuscitated cardiac arrest Fatal or nonfatal reinfarction All-cause hospitalization Losartan better tolerated than captopril as defined by permanent discontinuation of drug (17 vs. 23%, hazard ratio 0.70, 95% CI 0.62–0.79, P<0.0001)

    5. OPTIMAAL: Optimal Trial In Myocardial Infarction with the Angiotensin Antagonist Losartan - RESULTS continued -

    6. OPTIMAAL: Optimal Trial In Myocardial Infarction with the Angiotensin Antagonist Losartan - RESULTS continued -

    7. OPTIMAAL: Optimal Trial In Myocardial Infarction with the Angiotensin Antagonist Losartan - RESULTS continued -

    8. OPTIMAAL: Optimal Trial In Myocardial Infarction with the Angiotensin Antagonist Losartan - RESULTS continued -

    9. OPTIMAAL: Optimal Trial In Myocardial Infarction with the Angiotensin Antagonist Losartan - SUMMARY - In patients with acute MI and evidence of heart failure or left ventricular dysfunction, losartan 50 mg daily: Conferred no benefit in comparison with captopril Was better tolerated than captopril ACE inhibitors therefore remain the first-choice therapy in this group

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