Myocardial infarction: trandolapril decreased atrial fibrillation.

Clinical bottom line (level 1b)

  1. Patients with myocardial infarction who were given trandolapril, were less likely to have atrial fibrillation than those given placebo (NNT = 39 at 2 years) .
Pedersen et al: Circulation 1999; 100: 376-380
Expires March 2003

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: 27 centres, Denmark

1577 patients (aged mean 68 years, 72% male) acute myocardial infarction with impaired left ventricular function determined by echocardiography

Excluded if
  • 18 years old or less
  • not in sinus rhythm (for this analysis)


    • Note:
  • Patients in the trandolapril group had slightly higher diastolic blood pressure and nitrate treatment.


    • Control Group: (n = 787, 787 analysed): placebo
    Experimental Group: (n = 790, 790 analysed): trandolapril 1 mg/day and, if possible, increased to 2 mg/day before discharge. About 4 weeks after MI the dose was increased to 4 mg/day, if possible.

    100% followed for 2 years

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    atrial fibrillation 2 years 42
    (5.34%)    		 22
    (2.78%)    		 48%
    (13% to 69%)    		 2.55%
    (0.61% to 4.50%)    		 39
    (22 to 165)

    Citation

    1. Pedersen OG, Bagger H, Kober L, et al: Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction. Circulation 1999; 100: 376-380
    Contributor: Clare Wotton and Bob Phillips, January 2000
    Reviewer:

    Clinical Question.
    Patient MI and left ventricular dysfunction
    Intervention or Exposure trandolapril
    Comparison placebo
    Outcome atrial fibrillation