PREAMI
Perindopril Remodeling in Elderly with Acute
Myocardial Infarction
Presented at
The European Society of Cardiology Hot Line
Session, September 2005
Presented by Dr. Roberto Ferrari
PREAMI
1259 patients, Acute myocardial infarction in prior 7-20 days, age ≥65
years, LV ejection fraction ≥40%, good apical views of LV at baseline
echo
Placebo
Perindopril (4 mg for 1 month,
followed by 8 mg for 11 months)
Standard medical therapy;
echocardiography at 6 and 12 months
Standard medical therapy;
echocardiography at 6 and 12 months
Endpoints:


Primary – Composite of death, hospitalization for heart failure, or adverse cardiac
remodeling, defined as a >8% increase in LV end diastolic volume
Secondary – Individual components of the primary endpoint; LV end diastolic volume;
cardiovascular death, hospitalization for reinfarction or angina; CABG or PCI
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ESC 2005
PREAMI: Primary endpoint
• There was a 38% relative risk reduction in the primary composite
endpoint of CV death, recurrent MI, or stroke following PCI in the
Perindopril group compared to the placebo group (p<0.001).
Endpoint
Relative risk reduction with Perindopril
p-value
Death/HF hospitalization/remodeling
38
<0.001
Total mortality
0
0.9
Hospitalization for heart failure
27
0.24
Remodeling
46
<0.001
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ESC 2005
PREAMI: Secondary Endpoints
Cardiac Remodeling
% pts With Adverse Remodeling
p < 0.001
60%
51.2%
50%
40%
30%
27.7%
20%
10%
• The reduction in the primary
composite endpoint of death,
hospitalization for heart failure,
or heart remodeling was driven
by a significant reduction in
adverse cardiac remodeling in
the treatment group compared
to the placebo group.
Differences in mortality and
hospitalization for heart failure
were not significant between
groups.
0%
Peridopril
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Placebo
ESC 2005
PREAMI: Secondary Endpoints
12 Month LV End Diastolic Volume
Diastolic Volume (cc)
85
84
83.6
• LV end diastolic volume was
lower at 12 months in the
perindopril group compared with
placebo.
83
82
81.8
81
80
Peridopril
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Placebo
ESC 2005
PREAMI: Summary
Among elderly patients post-MI with preserved LV function, addition of the ACE-inhibitor
Perindopril to conventional therapy was associated with a reduction in the primary composite
endpoint of death, hospitalization for heart failure, or adverse heart remodeling, driven primarily
by the reduction in adverse remodeling, compared with placebo at 12 month follow-up.
•
• These data further support the prior trials that have demonstrated the benefit of ACE-inhibitor
therapy in patients with coronary artery disease. In the EUROPA trial, the benefit of long-term
perindopril therapy on cardiovascular death or MI was demonstrated among patients with lowrisk, stable coronary artery disease syndromes, including post-MI. The present trial further
defines these benefits among a cohort of elderly patients with preserved LV function.
• While no clinical benefit was observed in PREAMI, the sample size and duration of therapy
may have been insufficient to detect such a difference. Substudies from the EUROPA trial
suggested a mechanism of benefit via blood pressure reduction and anti-atherosclerotic
improvements such as endothelial function and nitric oxide increase. The PREAMI trial
suggests cardiac remodeling may also play a role in the mechanism of benefit with perindopril
post-MI. The study also demonstrates that LV remodeling can occur post-MI, despite small initial
infarct size.
www. Clinical trial results.org
ESC 2005