Comparison of the Efficacy and Safety of Sacubitril/Valsartan versus Ramipril in Patients With ST-Segment Elevation Myocardial Infarction

Autor: Ahmed Rezq, Mostafa El Nozahi, Marwan Saad
Rok vydání: 2021
Předmět:
Adult
Male
Ramipril
medicine.medical_specialty
Heart Diseases
medicine.medical_treatment
Myocardial Infarction
Tetrazoles
Angiotensin-Converting Enzyme Inhibitors
030204 cardiovascular system & hematology
Sacubitril
Angiotensin Receptor Antagonists
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Double-Blind Method
Internal medicine
medicine
Humans
030212 general & internal medicine
Myocardial infarction
Aged
Heart Failure
Ejection fraction
business.industry
Aminobutyrates
Biphenyl Compounds
Percutaneous coronary intervention
Stroke Volume
Middle Aged
medicine.disease
Hospitalization
Drug Combinations
Treatment Outcome
Valsartan
Cardiology
ST Elevation Myocardial Infarction
Female
Cardiology and Cardiovascular Medicine
business
Sacubitril
Valsartan
Mace
medicine.drug
Zdroj: The American Journal of Cardiology. 143:7-13
ISSN: 0002-9149
DOI: 10.1016/j.amjcard.2020.12.037
Popis: The role of sacubitril and/or valsartan in patient with heart failure (HF) is established. Whether sacubitril and/or valsartan plays a role in improving outcomes in patients after ST-segment elevation myocardial infarction (STEMI) is unknown. The current study aims to comparing the efficacy and safety of sacubitril and/or valsartan versus ramipril in post-STEMI patients. Patients presenting with STEMI were randomized to receive either sacubitril and/or valsartan or ramipril after primary percutaneous coronary intervention. The main efficacy endpoint was major adverse cardiac events (MACE) at 30 days and 6 months, defined as a composite of cardiac death, myocardial infarction, and HF hospitalizations. Multiple secondary clinical safety and efficacy endpoints were examined. A total of 200 patients were randomized from January 2018 to March 2019, mean age 54.5±10.4, 87% men, 75% presented with anterior wall STEMI. Baseline clinical and echocardiographic characteristics were comparable between groups. The primary endpoint of MACE was similar with sacubitril/valsartan versus ramipril at 30 days (p = 0.18); however, at 6 months, sacubitril/valsartan was associated with significant reduction of MACE (p = 0.005), mainly driven by reduction in HF hospitalizations (18% vs 36%, OR 0.40, 95% 0.22 to 0.75; p = 0.004). At 6 months, LV ejection fraction was higher with sacubitril/valsartan (46.8±12.5% vs 42.09±13.8%; p = 0.012), with improved LV remodelling (LV end diastolic dimension 50.6±3.9 mm vs 53.2±2.7 mm, p = 0.047; and LV end systolic dimension 36.1±3.4 mm versus 39.9±6.3 mm, p = 0.001) compared with ramipril. No difference in other efficacy or safety clinical endpoints was observed. In conclusion, early initiation of sacubitril/valsartan may offer clinical benefit and improvement in myocardial remodelling in post-STEMI patients.
Databáze: OpenAIRE
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