Sacubitril/valsartan use after STEMI improves outcomes, promotes vascular remodeling
Early sacubitril/valsartan initiation following STEMI improved clinical outcomes and promoted vascular remodeling compared with ramipril use, researchers reported.
“We believe that the value of sacubitril/valsartan needs to be explored not just in end-stage HF,” Ahmed Rezq, MD, PhD, faculty of medicine in the department of cardiology at Ain Shams University and Dar Al Fouad Hospital, Cairo, told Healio. “We believe that the early initiation of this drug would improve the long-term outcomes after MI.”
The randomized, active-controlled, double-blind, two-center study included 200 patients (mean age, 55 years; 87% men) presenting with STEMI from 2018 to March 2019 to assess the safety and efficacy of sacubitril/valsartan (Entresto, Novartis) compared with ramipril. Patients were randomly assigned to sacubitril/valsartan 100 mg twice daily or ramipril 5 mg twice daily following primary PCI.
The main efficacy endpoint was major adverse cardiac events, defined as cardiac death, MI and HF hospitalizations, at 30 days and 6 months.
At 30 days, major adverse cardiac events were similar in the sacubitril/valsartan group and the ramipril group (P = .18). At 6 months, sacubitril/valsartan initiation was associated with reduction of major adverse cardiac events (P = .005). The association was driven by reduced HF hospitalizations: 18% in the sacubitril/valsartan group compared with 36% in the ramipril group (OR = 0.4; 95% CI, 0.22-0.75; P = .004).
At 6 months, left ventricular ejection fraction was higher in the sacubitril/valsartan group compared with the ramipril group (46.8% vs. 42.09%; P = .012). LV remodeling was more pronounced in the sacubitril/valsartan group, with greater improvements in LV end diastolic dimension (50.6 mm vs. 53.2 mm; P = .047) and LV end systolic dimension (36.1 mm vs. 39.9 mm; P = .001) compared with the ramipril group.
Researchers observed no difference in other safety or efficacy clinical endpoints.
“Larger trials should be done to prove its efficacy on a larger scale, as this might change the practice in the nearby future, to help more patients and minimize hospitalization due to heart failure,” Rezq said. “We hope to collaborate with other centers worldwide to exchange our experiences and start different protocols in the field of cardiovascular medicine.”
For more information:
Ahmed Rezq, MD, PhD, can be reached at email@example.com.