GISSI-3 trial

19394 patients who presented within 24 hr of the onset of symptoms of acute myocardial infarction were randomised to:

• 6 weeks oral lisinopril vs. open control
• nitrates (i.v. then transdermal) vs. open control

Other treatments, such as aspirin, beta-blockers and thrombolytics, were administered as clinically indicated.

Lisinopril was found to significantly reduce:

• overall mortality at 6 weeks (odds ratio = 0.88)
• severe ventricular dysfunction (odds ratio = 0.90)

Nitrates alone did not have a significant effect.

The combination of nitrates and lisinopril was slightly better than lisinopril alone in reducing:

• overall mortality at 6 weeks (odds ratio = 0.83)
• severe ventricular dysfunction (odds ratio = 0.85)

Reference:

• GISSI-3: effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarction. (1994). Lancet, 343, 1115-22.
• Eisenberg PR (1996). Early treatment with lisinopril for 6 weeks reduced mortality at 6 months in acute MI. EBM, 1 (5), 139.