EUROPA Study - ESC 2005


	Effects of perindopril on long-term clinical outcome of patients with coronary artery disease and preserved left ventricular function-The EUROPA study Authors: M E Bertrand, WJ Remme1, KM Fox2, R Ferrari3, J Deckers4, ML Simoons5, Lambersart - France, 1Sticares Cardiovascular Research Found - Rotterdam - Netherlands, 2London - United Kingdom, 3Ferrara - Italy, 4Cardialysis - Rotterdam - Netherlands, 5Thorax Center - Rotterdam - Netherlands, Topic(s): Secondary prevention Angina pectoris, stable ACE inhibitors and AT2 blockers Background: The EUROPA trial has demonstrated that perindopril, an ACE inhibitor with high-tissue affinity, significantly decreased the risk of major cardiac events (CV death, non fatal myocardial infarction (MI) and cardiac arrest (CA)) in patients with stable coronary artery disease (CAD) without apparent heart failure (CHF). Since comparable secondary preventive effects have been previously demonstrated in patients with LV dysfunction, with/without CHF, our goal was to assess the long-term clinical outcome in patients with preserved left ventricular function (LV ejection fraction (LVEF) =40%) in the EUROPA study. Methods: Among the 12,218 patients (pts) in EUROPA we retrospectively identified 9,810 (80.3%) pts who had an LVEF assessment. The measurements were obtained by echocardiography in 6723 cases (68.5%) or by angiography in 2622 cases (26.7%). The mean LVEF of the overall population was 57� 10%. 9,478 (96.6%) pts had a LVEF = 40%: 4,730 received 8 mg of perindopril and 4,748 received a placebo. Only 332 pts (3.4%) had an LVEF< 40%, 175 received perindopril and 157 a placebo.In patients (n=332), with impaired LV function (LVEF < 40%), the primary endpoint was also reduced by perindopril ARR=2.5% (HR=0.86 [95% CI: 0.51-1.44] Results: The baseline characteristics of pts with documented LVEF were not different to the whole EUROPA population in terms of demographics, medical history, physical examination (heart rate, blood pressure), and medications at screening. In pts (n=9,478) with preserved LV function (LVEF = 40%), there was a significant relative risk reduction of 22% of the primary endpoint (CV death, non fatal MI and CA) in the group treated with perindopril: (7.8%) compared to placebo (9.9%). Absolute risk reduction (ARR) = 2.1%, hazard ratio (HR): 0.78 [95% CI: 0.68-0.90]) p < 0.001. Similar results were obtained for the first secondary endpoint (total mortality, non-fatal MI, hospital admission for unstable angina, CA): ARR=2.9% HR=0.82 [95% CI: 0.74-0.91] p < 0.001, for cardiovascular mortality and non fatal MI: ARR=2% HR= 0.78 [95% CI: 0.69-0.90] p < 0.001 as well as for fatal and non fatal MI: ARR:1.7% HR = 0.75 [95% CI: 0.64-0.89] p < 0.001. Conclusions: LVEF was documented in 80.3% of the EUROPA study population and only 3.4% had an impaired LV function, confirming that EUROPA patients did not have asymptomatic LV dysfunction. Results in patients with preserved LV function are consistent with those of the whole EUROPA study population. Perindopril is beneficial in all patients with stable CAD, irrespective of LV function. Back