Benefits of early administration of Sacubitril/Valsartan in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention

Abstract

Objective To evaluate the effects of early administration of Sacubitril/Valsartan (Sac/Val) in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention (pPCI). Methods This prospective, controlled, single-center study randomized 186 ST-segment elevation myocardial infarction patients to one of the following two groups: Sac/Val group: early administration of Sac/Val within 24 hours after pPCI; control group: conventional angiotensin-converting enzyme inhibitors (ACEI) application. The creatine Kinase (CK) peak after the surgery, the incidence of acute heart failure during hospitalization, level of NT-proBNP and left ventricular ejection fraction (LVEF) measured by ultrasound before discharge and soluble suppression of tumorigenicity2 (sST2), LVEF, infarct size determined by single photon emission computed tomography (SPECT), readmission rate within 6 months were recorded and compared between two groups. Results Compared to the control group, Sac/Val could decrease the CK peak and the incidence of acute heart failure after pPCI; the level of NT-proBNP was lower and LVEF was higher before discharge in the Sac/Val group. After 6 months, the patients who had taken Sac/Val had a higher LVEF, a smaller infarct size determined by SPECT, lower sST2 and readmission rate. Conclusion Patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention could benefit from early administration of Sacubitril/Valsartan, the effect was superior to conventional ACEI.

Efficacy and safety of early initiation of Sacubitril/Valsartan in patients after acute myocardial infarction: A meta‐analysis

“…Two trials 14,17 reported adequate sequence generation and one trial 15 reported adequate concealment of allocation. Two trials 15,16 had the risk of bias due to absence of blinding of participants and personnel and binding of outcome assessment. The GRADE system entails an assessment of the quality of a body of evidence which involves consideration of within-study risk of bias, directness of evidence, heterogeneity, precision of effect estimates and risk of publication bias for each individual outcome.…”

“…Three studies [14][15][16] involving 493 patients reported the MACE outcome. The significant heterogeneity was not noted between the included studies (I 2 = 0.0%, P = .414).…”

“…The forest plots of the effectiveness and safety outcomes between early initiation of Sacubitril/Valsartan and angiotensinconverting enzyme inhibitors in patients after acute myocardial infarction. (A) The forest plots of the incidence of cardiac death, (B) the forest plots of the incidence of heart failure hospitalization, (C) the forest plots of the incidence of major adverse cardiac events, (D) the forest plots of the left ventricular ejection fraction 3.7 | LVEF outcome in patients after AMI Three studies [14][15][16] involving 483 patients reported the LVEF outcome. The significant heterogeneity was not noted between the included studies (I 2 = 0.0%, P = .399).…”

Clinical outcomes of Sacubitril/Valsartan in patients with acute heart failure: A multi-institution study

“…They found superior short-term and long-term benefits in preventing MI-induced LV dysfunction with sacubitril/valsartan compared to valsartan. Another study by Zhang et al also demonstrated a lower readmission rate, smaller infarction size, and higher LVEF with sacubitril/valsartan treatment compared with ACEIs at 6 months in patients with ST-elevation MI after primary PCI [20]. The exact mechanism associated with the beneficial effect of sacubitril/valsartan in patients receiving PCI is unclear, however several potential mechanisms have been postulated.…”

Duálna inhibícia neprilyzínu a receptora typu 1 pre angiotenzín II vo svetle klinických štúdií / Dual inhibition of neprilysin and angiotensin II type 1 receptor in light of clinical studies

“…V štúdii na 137 pacientoch so systolickou dysfunkciou ĽK po akútnom infarkte prednej steny myokardu a perkutánnej koronárnej intervencii, sakubitril/ valsartan zmiernil remodeláciu a dysfunkciu ĽK a znížil výskyt závažných kardiovaskulárnych udalostí v porovnaní s enalaprilom (48). Na 186 pacientoch s infarktom myokardu s eleváciou ST-segmentu, včasné podanie sakubitril/valsartanu (vs. konvenčné ACEi) do 24 hodín po perkutánnej koronárnej intervencii redukovalo veľkosť infarktu meraného šesť mesiacov po príhode pomocou emisnej počítačovej tomografie (SPECT) (49). V súčasnosti prebieha multicentrická štúdia PARADISE-MI za účelom porovnania účinku sakubitril/ valsartanu a ramiprilu na kompozitný endpoint kardiovaskulárnej mortality, hospitalizácie pre SZ a ambulantného SZ u pacientov po prekonaní infarktu myokardu so systolickou dysfunkciou ĽK a štandardnou terapiou (50).…”