The Effects of Sacubitril / Valsartan on Major Adverse Cardiac Events to the Patients of Acute Myocardial Infarction: A Meta-analysis

Abstract

Sacubitril / valsartan is widely used in the patients of heart failure (HF) as an angiotensin receptor-neprilysin inhibitor (ARNI). However, the effects in patients of acute myocardial infarction (AMI) remain unclear. Therefore, in the patients of AMI,we performed this meta-analysis to explore the effects of ARNI on major adverse cardiac events(MACEs). We searched Cochrane Library, Pub-Med, Web of Science, Embase, China National Knowledge Infrastructure, WanFang, and VIP for randomized controlled trials (RCTs) published up to January 2021, with no language restrictions, compared angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs) with ARNI to analyze their effects on MACEs in patients with AMI. All studies met the inclusion and exclusion criteria. PROSPERO registration: CRD42021256018. Our primary outcomes were MACEs, including all-cause mortality, nonfatal myocardial infarction, hospitalization for HF, malignant car-diac event or cardiac death, stroke,re-admission for cardiovascular disease, angina pectoris, malig-nant arrhythmia, and coronary artery reconstruction. Secondary outcomes included acute or sub-acute thrombosis, bleeding again, and nonfatal cardiogenic shock. Eleven RCTs (1,125 patients) were recruited. Compared with ACEI / ARBs, sacubitril / valsartan decreased the hospitalization rates for HF (odds ratio(OR), 0.44; 95% confidence interval (CI): 0.33-0.59) and re-admission for cardiovascular diseases (OR, 0.41; 95% CI: 0.18-0.94) in patients with AMI. However, no obvious benefits were found on other MACEs. In the patients of AMI, sacubitril / valsartan decreased the hos-pitalization rate for HF and re-admission for cardiovascular disease compared with ACEI/ARBs, with no obvious effects on other MACEs.