- Question
- To assess whether lisinopril, transdermal glyceryl trinitrate (GTN), or their combination improve survival and ventricular function after acute myocardial infarction.
- Design
- Multicentre, randomised, open-label trial with a factorial design that enrolled 19394 patients from 200 coronary care units in Italy between June 1991 and July 1993. Complete clinical data and 6-week follow-up were available for 18895 patients.
- Population
- Patients with acute myocardial infarction presenting within 24 hours of symptom onset and with no clear indication for or against the study treatments.
- Intervention
- Oral lisinopril (5 mg initial dose, then 10 mg daily) for 6 weeks and/or nitrates (intravenous for the first 24 hours, then transdermal GTN 10 mg daily), given alone or together.
- Control
- Open control without the corresponding drug, within the factorial design.
- Primary outcome
- 6-week mortality and the combined outcome of mortality and severe ventricular dysfunction.
- Results
- Overall 6-week mortality was 6.7%. Lisinopril reduced mortality (OR 0.88; 95% CI 0.79-0.99) and the combined outcome (OR 0.90; 95% CI 0.84-0.98). GTN showed no independent effect on mortality (OR 0.94; 95% CI 0.84-1.05) or the combined outcome (OR 0.94; 95% CI 0.87-1.02). The combination also reduced mortality (OR 0.83; 95% CI 0.70-0.97).
- Safety
- No excess of clinically relevant unfavourable events was reported in the treated groups.
- Conclusion
- Lisinopril started within 24 hours of myocardial infarction reduced short-term mortality, whereas routine GTN offered no independent benefit.
- Why it matters
- It supported early initiation of an ACE inhibitor in acute myocardial infarction, even amid intensive use of thrombolysis, beta-blockers and aspirin, and argued against routine nitrate use.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 10, 2026