ACE抑制剂治疗新动态.pptVIP

CHARM Programme CHARM Added CHARMPreserved 3 component trials comparing candesartan to placebo in patients with symptomatic heart failure CHARMAlternative n=2028 LVEF ￡40%ACE inhibitor intolerant n=2548 LVEF ￡40%ACE inhibitor treated n=3025 LVEF 40%ACE inhibitor treated/not treated Primary outcome for Overall Programme: All-cause death Primary outcome for each trial: CV death or CHF hospitalisation CHARM-Alternative Trial Median follow-up of 33.7 months Candesartan n=1013 Placebo n=1015 Completed Study n=1011 Completed Study n=1014 Lost to follow-up n=2 Lost to follow-up n=1 2028 patients randomised NYHA II~IV, LVEF ?40%ACE inhibitor intolerant CHARM-Alternative: Primary outcome CV death or CHF hospitalisation Number at risk Candesartan 1013 929 831 434 122 Placebo 1015 887 798 427 126 0 1 2 3 years 0 10 20 30 40 50 Placebo Candesartan % HR 0.77 (95% CI 0.67~0.89), p=0.0004Adjusted HR 0.70, p0.0001 3.5 406 (40.0%) 334 (33.0%) CHARM-Added Trial Median follow-up of 41 months Candesartan n=1276 Placebo n=1272 Completed Study n=1273 Completed Study n=1271 Lost to follow-up n=3 Lost to follow-up n=1 2548 patients randomised NYHA II~IV, LVEF ? 40%ACE inhibitor treated CHARM-Added: Primary outcomeCV death or CHF hospitalisation Number at risk Candesartan 1276 1176 1063 948 457 Placebo 1272 1136 1013 906 422 0 1 2 3 years 0 10 20 30 40 50 Placebo Candesartan 3.5 HR 0.85 (95% CI 0.75~0.96), p=0.011Adjusted HR 0.85, p=0.010 483 (37.9%) 538 (42.3%) % CHARM试验的临床意义 ARB用于慢性收缩性心力衰竭患者是有效的 康得沙坦显著降低心血管病死亡和病残联合终点事件发生率 总死亡率未能显著降低，提示疗效不如ACE抑制剂 ARB作为心力衰竭治疗二线药物（替代）的地位得到确立 ARB和ACE抑制剂合用有相加的效益 康得沙坦显著降低心血管病死亡和病残联合终点事件发生率 ARB、ACE抑制剂和?-阻滞剂三药合用可能是安全的 已用ACE抑制剂和?-阻滞剂的患者是否加ARB，仍需研究 Standard post-AMI care ASA, BB, ACEI, statin, revascularization Post-AMI (3~14 d),