Perindopril significantly reduces the risk of death, hospitalization for heart failure, and cardiac remodeling in elderly survivors of myocardial infarction with preserved left ventricular function, according to a presentation at the annual meeting of the European Society of Cardiology.

The PREAMI (Perindopril Remodelling in Elderly with Acute Myocardial Infarction) study is the first to evaluate an angiotensin-converting enzyme inhibitor in this elderly population, which is widely represented in clinical practice.

The beneficial effect of perindopril was due to a highly significant 46-percent reduction in cardiac remodeling compared with placebo. Previous studies had demonstrated the beneficial effect of this drug class in younger patients with decreased left ventricular function.

"The PREAMI findings fill a gap in our knowledge of the effect of ACE inhibitors in post-myocardial infarction patients," said Professor R. Ferrari from Santa Anna Hospital, University of Ferrara, Italy, and lead investigator of the PREAMI study.

"PREAMI demonstrated that, even in patients who survived a heart attack and who have normal left ventricular function more than 10 days after acute phase, progressive cardiac remodeling silently appears. The good news is that perindopril can significantly prevent this cardiac decline and could be of benefit to millions of post-myocardial infarction elderly patients."

The multinational, double-blind, randomized, parallel, multi-center study compared perindopril (8 mg/day with placebo in 1,252 elderly (average age, 73 years) post-myocardial infarction patients with a left ventricular ejection fraction of 40 percent or more.

Patients received recommended usual therapy (anti-thrombotics, beta-blockers, and angiotensin-converting enzyme inhibitors). The 1,252 patients with preserved left ventricular function were randomized 11 +/- 4 days after infarction to the additional therapy of 4 mg/day perindopril or placebo for the first month of treatment, followed by 8 mg/day perindopril or placebo for the remaining 11 months of the trial.

Perindopril was associated with a highly significant relative risk reduction of 38 percent in the combined primary end point (death, hospitalization for heart failure, cardiac remodeling). The results showed significantly less left ventricular remodeling in the perindopril group compared with the placebo group (28 versus 51 percent).