Effect of ramipril on postrevascularization prevalence of angina and quality of life

Background: The prevalence of angina after invasive revascularization is not negligible and impacts on quality of life. It has not been clarified whether potential anti-ischemic actions of angiotensin-converting enzyme inhibitors (1) may apply to non high-risk patients and (2) may reduce the prevalence of angina. We sought to test the hypothesis that ramipril, an angiotensin-converting enzyme inhibitor, may reduce the postrevascularization prevalence of angina pectoris and improve quality of life. Methods: In the Angiotensin-converting enzyme Post-Revascularization Study (APRES), 159 patients who underwent invasive revascularization for chronic angina and who had not had heart failure, acute myocardial infarction (AMI), or severe left ventricular dysfunction were randomized to receive 10 mg of ramipril or placebo. During the 12- to 46-month follow-up, the Specific Activity Scale class, exercise tests, and SF-36 quality of life scores were serially assessed. Results: The average prevalence of angina of Specific Activity Scale class II or worse was 26.6% in the ramipril group and 19.9% in the placebo group (p=0.16). The average prevalence of exercise-inducible ischemia was 30.8% in the ramipril group and 25.2% in the placebo group (p=0.39). There were no significant differences between the two treatment groups in the SF-36 quality of life scores or in the Duke treadmill score. Post-hoc power calculations revealed that the power to rule out a clinical significant benefit of ramipril on the prevalence of angina, quality of life, and Duke treadmill score was >90%. Conclusions: These data do not suggest that ramipril reduces the prevalence of angina pectoris or improves quality of life after invasive revascularization in such patients