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Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function

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Results of Trials Evaluating the Addition of an ACEI or an ARB to Standard Medical Therapy (SMT) Versus SMT Alone Close to a Revascularization Procedure

This slide summarizes the most pertinent results from the Comparative Effectiveness Review (CER) on the benefits and harms of adding an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) to standard medical therapy, as opposed to standard medical therapy alone, in patients with stable ischemic heart disease (IHD) and preserved left ventricular systolic function (LVSF) who have recently undergone, or are about to undergo, a revascularization procedure.

Although ACEIs or ARBs may be beneficial to patients with stable IHD and preserved LVSF, no significant clinical benefits were identified in the CER analysis among such patients who were in close proximity to a revascularization procedure. Moreover, there was an increased risk of adverse events when an ACEI or an ARB was administered within 2 weeks before or after such a procedure. In four large clinical trials (i.e., HOPE, EUROPA, PEACE, and TRANSCEND), patients with stable IHD and preserved LVSF who had a revascularization procedure within 3 to 6 months of trial enrollment were excluded.

Given these results, it is likely that this subpopulation of patients with stable IHD and preserved LVSF who are in close proximity to a revascularization procedure are characteristically different from patients who underwent revascularization at least 3 to 6 months ago. The following slides discuss these data in greater detail.