Thirty-four trials were identified, of which 32 were included in the meta-analysis (n=7,105).
Overall, 611 of the 3,870 patients allocated to an ACE inhibitors group (15.8%) and 709 of the 3,235 controls (21.9%) died (OR 0.77, 95% CI: 0.67, 0.88). Most of the benefit occurred in the first 90 days (OR 0.56, 95% CI: 0.44, 0.70, p<0.001; 32 trials). The benefit beyond 90 days was not statistically significant (OR 0.87, 95% CI: 0.75, 1.01; 12 trials).
Overall, 854 of the 3,810 patients on active treatment (22.4%) and 1,036 of the 3,178 patients on placebo (32.6%) died or were hospitalised for CHF (OR 0.65, 95% CI: 0.57, 0.74, p<0.001; 30 trials). The OR for CHF in the first 90 days of treatment was 0.53 (95% CI: 0.44, 0.63, p<0.001; 30 trials), and beyond 90 days was 0.76 (95% CI: 0.66, 0.88; 10 trials).
The most common cause of death was progressive heart failure, which was less frequent in the treatment group (OR 0.69, 95% CI: 0.58, 0.83, p<.001). Fatal and nonfatal myocardial infarction were significantly reduced in the treatment group (OR 0.80, 95% CI: 0.64, 0.99, p=0.04).
Death due to sudden or presumed arrhythmic events or myocardial infarction, and the incidence of strokes, pulmonary emboli or other thromboembolic events, were not statistically significant between groups.
The results of subgroup analyses were reported.