OPTIMAAL研究PPT课件.ppt

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1、OPTIMAAL:OptimalTrialInMyocardialInfarctionwiththeAngiotensinAntagonistLosartanPurposeTodeterminewhethertheangiotensinIIreceptorblockerlosartanissuperiororinferiortotheangiotensinconvertingenzyme(ACE)inhibitorcaptoprilinreductionofall-causemortalityinhigh-riskpatientsafteracuteMIReferenceDicks

2、teinK,KjekshusJandtheOPTIMAALSteeringCommittee,fortheOPTIMAALStudyGroup.Effectsoflosartanandcaptoprilonmortalityandmorbidityinhigh-riskpatientsafteracutemyocardialinfarction:theOPTIMAALrandomisedtrial.Lancet2002;360:752–60.OPTIMAAL:OptimalTrialInMyocardialInfarctionwiththeAngiotensinAntagonist

3、Losartan-TRIALDESIGN-DesignMulticenter,multinational,randomized,double-blind,parallel-groupPatients5466patientsaged>50yearswithacuteMIandevidenceofheartfailureorleftventriculardysfunction(leftventricularejectionfraction<35%)FollowupandprimaryendpointPrimaryendpoint:all-causemortality.Mean2.7ye

4、arsfollowupTreatmentCaptopril(titratedtotargetdose50mgthreetimesdaily,astolerated)orlosartan(titratedtotarget50mgdaily,astolerated)OPTIMAAL:OptimalTrialInMyocardialInfarctionwiththeAngiotensinAntagonistLosartan-TRIALDESIGNcontinued-Meanage(years)Male(%)HistoryMeanBP(mmHg)MedicationsTimetorando

5、mization(h)Hypertension(%)PreviousMI(%)SystolicDiastolicThrombolytic(%)Beta-blocker(%)Aspirin(%)Statin(%)Baselinecharacteristics67123.071.584.972361854799530Losartan(n=2733)67122.871.484.971361854799631All(n=5477)67122.571.48571361855789631Captopril(n=2744)Dicksteinetal.Lancet2002;360:752–60.O

6、PTIMAAL:OptimalTrialInMyocardialInfarctionwiththeAngiotensinAntagonistLosartan-RESULTS-All-causemortalitynonsignificantlyhigherinlosartangroupcomparedwithcaptopril(18.2vs.16.4%,P=0.069)MortalitycurvesseparatedearlyonandthenlargelyremainedparallelNonsignificantdifferenceinfavorofcaptoprilin:Sud

7、dencardiacdeathorresuscitatedcardiacarrestFatalornonfatalreinfarctionAll-causehospitalizationLosartanbettertoleratedthancaptoprilasdefinedbypermanentdiscontinuationofdrug(17vs.23%,hazardratio0.70,95%CI0.62–0.79,P<0.0001)OPTIMAAL:Optimal