Long-Term Survival of Non-Elderly Patients With Severe Heart Failure Treated With Angiotensin-Converting Enzyme Inhibitors. Assessment of Treatment With Captopril and Enalapril Survival Study (ACESS).

The present study examined the effect of treatment with angiotensin-converting enzyme inhibitors (ACEIs) on the long-term prognosis in 119 patients with dilated cardiomyopathy (DCM). Conventional therapy was used in 29 patients and 90 patients were treated with ACEIs: 50 were taking captopril and 40 were taking enalapril; 24 were taking > or = 75 mg captopril or > or = 20 mg enalapril daily (high-dose group) and 66 patients received smaller doses (low-dose group). No significant differences between groups were detected with respect to demographics and clinical signs of congestive heart failure (CHF). During follow-up, 65 patients survived and 54 patients died: 34 patients were in group 1 and 20 patients were in the placebo group. Patients treated with ACEIs had a significantly better survival during the first to third year, but the difference was not significant between the high- and low-dose groups. Comparison of the cumulative probability of death in the enalapril and captopril groups showed a trend of significant reduction of mortality by 13% in the enalapril group (p<0.10). These data indicate that ACEIs have a beneficial effect on prolonging the short- and long-term survival in DCM patients, so it is strongly recommended that all patients with DCM should be treated with ACEIs unless contraindicated. In this study, lower doses of ACEI seemed prognostically equivalent to higher doses, and enalapril appeared to be preferable to captopril in the treatment of severe CHF. Additional prospective large studies are necessary to verify the relationship observed here between the optimal dosage as well as the duration of action of different ACEIs and their outcomes.