787-2 Addition of ACE Inhibitors to Beta Blockers or Calcium Channel Blockers Improves Mortality in Patients with CAD

Patients (n = 3676) with the diagnosis (Dx) of CAD discharged from our institution from 1/88 and 1/93 were followed for a mean duration of 33.3 months. Using multiple logistic regression, with all cause mortality as the end point, combinations of therapy (Rx) with either ACE inhibitors (A) or beta blockers (B) or calcium channel blockers IC) were compared to Rx with C alone (n = 378). Age and the Dx of CHF, MI, COPD, DM, PVD, hypercholesterolemia, CABG and PTCA were entered into the model. Results Rx n odds ratio p value 95% C.I. A + B 197 0.51 l0.01 0.33–0.79 A + B + C 558 0.58 l0.01 0.42–0.81 B 429 0.66 0.03 0.46–0.95 B + C 794 0.7 0.02 0.52–0.95 A + C 291 0.96 0.81 0.67–1.37 A 197 1.16 0.47 0.78–1.72 None 832 1.88 l0.001 1.42–2.50 Rx with A in combination with 8 significantlyimproves mortality when compared to Rx with C even after controlling for CHF . Significant differences in the prevalence of CH F in various Rx groups (53% in A and 5% in Band 11% in C) and inability to adequately control for the severity of CHF may explain the observed effect of Rx with A alone. Conclusions Combination Rx with A and 8 is preferable to Rx with Calone. It appears that mortality benefit of ACE Inhibition in patients with CAD is not limited to patients who have CHF .