Effect of Captopril on Mortality and Morbidity in Patients with Left Ventricular Dysfunction after Myocardial Infarction: Results of the Survival and Ventricular Enlargement Trial

Pfeffer, Marc A.; Braunwald, Eugene; Moyé, Lemuel A.; Basta, Lofty; Brown, Edward J.; Cuddy, Thomas E.; Davis, Barry R.; Geltman, Edward M.; Goldman, Steven; Flaker, Greg C.; Klein, Marc; Lamas, Gervasio A.; Packer, Milton; Rouleau, Jacques; Rouleau, Jean L.; Rutherford, John; Wertheimer, John H.; Hawkins, C. Morton

doi:10.1056/nejm199209033271001

Cited by 5,911Heart Failure Treatment and ManagementCardiac Fibrosis and RemodelingRenin-Angiotensin System Studies

Effect of Captopril on Mortality and Morbidity in Patients with Left Ventricular Dysfunction after Myocardial Infarction: Results of the Survival and Ventricular Enlargement Trial

Pfeffer, Marc A., Braunwald, Eugene, Moyé, Lemuel A., Basta, Lofty, Brown, Edward J., Cuddy, Thomas E., Davis, Barry R., Geltman, Edward M. +10 more·1992·New England Journal of Medicine

DOI 10.1056/nejm199209033271001

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Abstract

Background Left ventricular dilatation and dysfunction after myocardial infarction are major predictors of death. In experimental and clinical studies, longterm therapy with the angiotensin-converting--enzyme inhibitor captopril attenuated ventricular dilatation and remodeling. We investigated whether captopril could reduce morbidity and mortality in patients with left ventricular dysfunction after a myocardial infarction. Methods Within 3 to 16 days after myocardial infarction, 2231 patients with ejection fractions of 40 percent or less but without overt heart failure or symptoms of myocardial ischemia were randomly assigned to receive doubleblind treatment with either placebo (1116 patients) or captopril (1115 patients) and were followed for an average of 42 months. Results Mortality from all causes was significantly reduced in the captopril group (228 deaths, or 20 percent) as compared with the placebo group (275 deaths, or 25 percent); the reduction in risk was 19 percent (95 percent confidence interval, 3 to 32 percent; P = 0.019). In addition, the incidence of both fatal and nonfatal major cardiovascular events was consistently reduced in the captopril group. The reduction in risk was 21 percent (95 percent confidence interval, 5 to 35 percent; P = 0.014) for death from cardiovascular causes, 37 percent (95 percent confidence interval, 20 to 50 percent; P less than 0.001) for the development of severe heart failure, 22 percent (95 percent confidence interval, 4 to 37 pe…

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In the SAVE study, treatment with captopril reduced the development of heart failure by 37% in asymptomatic people with reduced LVEF after MI.
“which enrolled asymptomatic people with reduced LVEF after MI, including 23% people with diabetes, treatment with captopril reduced the development of heart failure by 37% (279).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [279]
In the SAVE study, treatment with captopril reduced the development of heart failure by 37% in asymptomatic people with reduced LVEF after MI.
“In the Survival and Ventricular Enlargement (SAVE) study, which enrolled asymptomatic people with reduced LVEF after MI, including 23% people with diabetes, treatment with captopril reduced the development of heart failure by 37% (276).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [276]

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Authors: Pfeffer, M. A., Braunwald, E., Moyé, L. A., Basta, L., Brown, E. J., Cuddy, T. E., Davis, B. R., Geltman, E. M., Goldman, S., Flaker, G. C., Klein, M., Lamas, G. A., Packer, M., Rouleau, J., Rouleau, J. L., Rutherford, J., Wertheimer, J. H., & Hawkins, C. M.
Affiliations: Brigham and Women's Hospital (US)
ORCID: Pfeffer, Marc A.
Davis, Barry R.
Goldman, Steven
Lamas, Gervasio A.
Packer, Milton
Rouleau, Jacques
Rouleau, Jean L.
Hawkins, C. Morton
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1992-09-03
Volume: 327
Issue: 10
Pages: 669-677
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm199209033271001
OpenAlex: W2312388685
Cited by: 5,911
References: 1
Citations by year: 2026: 42 · 2025: 66 · 2024: 74 · 2023: 66 · 2022: 94 · 2021: 92 · 2020: 90 · 2019: 81 · 2018: 89 · 2017: 125 · 2016: 126 · 2015: 125 · 2014: 121 · 2013: 122 · 2012: 146
FWCI: 227.94
Type: journal article
Language: en
Open access: closed
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
Keywords: captopril, ACE inhibitors, left ventricular dysfunction, myocardial infarction, mortality, morbidity, congestive heart failure, reinfarction, cardiovascular events, ejection fraction, long-term treatment, thrombolysis, aspirin, beta-blockers, left ventricular remodeling, left ventricular dilatation, survival
MeSH terms: Adult, Captopril, Cardiovascular Diseases, Double-Blind Method, Female, Cardiomegaly, Heart Failure, Humans, Male, Middle Aged, Myocardial Infarction, Patient Compliance, Stroke Volume, Survival Rate, Ventricular Function, Left

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Effect of Captopril on Mortality and Morbidity in Patients with Left Ventricular Dysfunction after Myocardial Infarction: Results of the Survival and Ventricular Enlargement Trial

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