While entry into this trial was not restricted to patients who
had sustained MI, its importance merits mention in this forum. A total
of 9,297 high-risk patients (age > 55 years, with a history of
coronary artery disease, stroke, peripheral vascular disease or
diabetes, and one other cardiovascular risk factor) were randomized to
placebo or ramipril group and followed up for 5 years. Treatment with
ramipril reduced overall mortality (10.4% vs 12.2%; p = 0.005),
cardiovascular death (6.1% vs 8.1%; p < 0.001), MI (9.9% vs
12.3%; p < 0.001), and stroke (3.4% vs 4.9%; p < 0.001).
Angiotensin-converting enzyme inhibitors were known to decrease
mortality in patients with ejection fraction < 40% after MI. This
study supports use of ramipril in all patients after MI.