Abstract
Some randomized controlled trials have compared the effectiveness and safety outcomes between early initiation of Sacubitril/Valsartan and angiotensin‐converting enzyme inhibitors (ACEIs) in patients after acute myocardial infarction. Therefore, our current meta‐analysis aimed to clarify the confusion. Four Databases and relevant grey literature were searched for studies from inception to July 2, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias. Four studies involving 6154 patients were included to perform meta‐analysis. The results of meta‐analysis showed that the left ventricular ejection fraction in the Sacubitril/Valsartan group was higher than the ACEI group (SMD: 0.37, 95% CI: 0.19–0.55, P = .000), the incidence of major adverse cardiac events in the Sacubitril/Valsartan group was lower than the ACEI group (RR: 0.61, 95% CI: 0.46–0.82, P = .001), while the incidences of cardiac death (RR: 1.00, 95% CI: 0.81–1.24, P = 1.000) and the heart failure hospitalization (RR: 0.62, 95% CI: 0.37–1.03, P = .065) showed no difference. For the incidences of myocardial infarction and the adverse side effects, there was no obvious advantage of the Sacubitril/Valsartan group over the ACEI group, because the meta‐analysis was not performed due to the limited trials. This study indicated that early initiation of Sacubitril/Valsartan in patients after acute myocardial infarction was superior to ACEI in reducing the risks of major adverse cardiac events and left ventricular ejection fraction increasing. As for the other outcomes (the incidences of cardiac death, the heart failure hospitalization, the myocardial infarction and the adverse side effects), Sacubitril/Valsartan showed no obvious advantage than ACEI.
Highlights
Despite the remarkable advances in the treatment of coronary artery disease and acute myocardial infarction (AMI) over the past two decades, AMI remains the most common cause of heart failure (HF).[1]The development of HF increases total mortality risk three-fold among patients with a history of MI.[2]
The meta-analysis showed that the incidence of major adverse cardiac events (MACE) in the Sacubitril/Valsartan group was lower than the angiotensin-converting enzyme inhibitor (ACEI) group (RR: 0.61, 95% CI: 0.46–0.82, P = .001; Figure 2(C))
The meta-analysis showed that the LVEF in the Sacubitril/Valsartan group was higher than the ACEI group (SMD: 0.37, 95% CI: 0.19–0.55, P = .000; Figure 2(D))
Summary
Despite the remarkable advances in the treatment of coronary artery disease and acute myocardial infarction (AMI) over the past two decades, AMI remains the most common cause of heart failure (HF).[1]. Sacubitril/Valsartan, which consists of the neprilysin inhibitor sacubitril and the ARB valsartan, has been approved for patients with symptomatic heart failure with reduced ejection fraction (HFrEF) and is intended to be substituted for ACEIs or ARBs.[7,8] In the PARADIGM-HF study, Sacubitril/Valsartan in HFrEF patients reduced HF hospitalization by 20% compared with ACEI enalapril.[7] The PIONEER-HF study showed that early initiation of Sacubitril/Valsartan in MI patients with left ventricle systolic dysfunction could reduce the level of NT-pro BNP.[9] In recent years, many researchers focused on whether AMI patients benefit of early initiation of Sacubitril/Valsartan.[10,11,12] there is still a lack of relevant clinical evidence We conducted this meta-analysis to investigate the efficacy and safety of early initiation of Sacubitril/ Valsartan in patients after AMI. In the case of missing information in the included studies, investigators were contacted by email to obtain the missing information
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