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GISSI-3 Sub-study - Effect of the ACE Inhibitor Lisinopril on Mortality in Diabetic Patients with Acute Myocardial Infarction


  • This was a retrospective study analysis using the data from the GISSI-3 study, which was a randomized, controlled, multicenter trial in 18,131 patients suspected to have acute myocardial infarction (AMI).
  • The initiation of an ACE-inhibitor (lisinopril) within 24 hours of symptom onset in diabetic patients was associated with a significant reduction in death at 6 weeks.
  • The survival benefit was maintained for 6 months despite the withdrawal of therapy at 6 weeks.

Landmark or Original Studies

  • Zuanetti G, et al. Effect of the ACE inhibitor lisinopril on mortality in diabetic patients with acute myocardial infarction. Data from the GISSI-3 Study. Circulation 1997; 96: 4239-4245. PubMed
    LOE 1b
    Study Design This was a retrospective analysis of the The GISSI-3 trial, which was a randomized, controlled, open, multicenter trial
    Sample Size N = 18,131 (original study); 2,790 had diabetes
    Population Adults with suspected AMI
    Treatment Lisinopril (2.5 to 5 up to 10 mg/d) +/- nitroglycerin (5 to 20 microg I.V. then 10 mg/d) started within 24 hours and continued for 6 weeks
    Duration 6 weeks of treatment, then stopped
    Follow-Up 6-weeks and 6-months
    Primary Endpoint Mortality at 6 weeks
    • Treatment with lisinopril was associated with a decreased 6-week mortality in diabetic patients (8.7% versus 12.4%; OR, 0.68; 95% CI, 0.53 to 0.86; 37+/-12 lives saved per 1000 treated patients), an effect that was significantly (P<.025) higher than that observed in nondiabetic patients.
    • The survival benefit in diabetics was mostly maintained at 6 months despite withdrawal from treatment at 6 weeks (12.9% versus 16.1%; OR, 0.77; 95% CI, 0.62 to 0.95).
    Conculsions "Early treatment with the ACE inhibitor lisinopril in diabetic patients with acute MI is associated with a decreased 6-week mortality. This beneficial effect supports a widespread and early use of ACE inhibitors in diabetic patients with acute MI. The burden of mortality plus morbidity for ventricular dysfunction in diabetics remains clinically important and warrants further testing of novel therapeutic approaches."

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MESH Terms & Keywords

  • GISSI-3 Study, ACE Inhibitors Lisinopril, Diabetes Mellitus