Whether angiotensin-converting enzyme (ACE) inhibitors are interchangeable and equally
efficacious after acute myocardial infarction (AMI) is controversial. We assessed whether
ramipril was superior to other ACE inhibitors after AMI as suggested by a previously
published study. We performed a retrospective cohort study using linked administrative
databases on >1.4 million elderly residents in the province of Ontario who were admitted
to the hospital for AMI, survived >30 days after discharge, and were initiated on an ACE
inhibitor after AMI and remained on the same ACE inhibitor from April 1, 1997 to March
31, 2000. We followed patients for 2 years and measured readmission for AMI or mortality,
together or alone. Our cohort included 5,408 elderly patients. Compared with patients on
enalapril, there was no significant difference for the combined end points of readmission for
AMI or mortality across users of ramipril (adjusted hazard ratio 0.95, 95% confidence
interval 0.79 to 1.15), lisinopril (adjusted hazard ratio 1.02, 95% confidence interval 0.84 to
1.25), or other ACE inhibitors (adjusted hazard ratio 1.08, 95% confidence interval 0.88,
1.32). In conclusion, the findings of this study support a class effect among ACE inhibitors
in treatment after AMI. © 2006 Elsevier Inc. All rights reserved. (Am J Cardiol 2006;98:
6–9)