Annals of medicine and surgery (2012) · 2026
Evaluating the effects of sacubitril/valsartan with ST-elevated myocardial infarction: a systematic review and meta-analysis.
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Kumar Ajay, Kumar Rohit, Kumari Simran, Muskan, Kashish, Kumar Aakash, Kumari Kiran, Kumari Radhika, Hussain Faraz, Simran, Jawad Sayed
Аннотация
BACKGROUND: ST-segment elevation myocardial infarction (STEMI) continues to be a leading cause of cardiovascular (CV) morbidity and mortality worldwide, posing an ongoing clinical and public health burden. Although angiotensin-converting enzyme inhibitors (ACEIs) remain integral to guideline-recommended therapy following STEMI, recent evidence indicates that sacubitril/valsartan may offer superior cardioprotective benefits. This meta-analysis aims to systematically evaluate and compare the efficacy and safety of sacubitril/valsartan versus ACEIs in the management of patients with STEMI.
METHODS: PubMed and Cochrane databases were systematically searched from inception to July 2024 to identify randomized controlled trials (RCTs) comparing sacubitril/valsartan and ACEIs in patients with STEMI. Data were synthesized using a random-effects model to calculate risk ratios (RRs) and weighted mean differences (WMDs), each with 95% confidence intervals (CIs). A P-value < 0.05 was considered statistically significant.
RESULTS: A total of five RCTs comprising 4915 participants were included in the final analysis. Sacubitril/valsartan therapy was associated with a significant reduction in major adverse cardiovascular events (MACE) [RR: 0.66 (0.50, 0.86); P = 0.002] and hospitalizations for heart failure (HHF) [RR: 0.67 (0.49, 0.92); P = 0.01]. Treatment with sacubitril/valsartan also significantly improved left ventricular ejection fraction (LVEF) [WMD: 2.60 (1.53, 3.68); P < 0.00001] and reduced NT-proB-type natriuretic peptide (NT-proBNP) levels (WMD: -268.89 [-422.35, -115.42]; P = 0.0006). No significant differences were observed in the risk of recurrent myocardial infarction [RR: 1.02 (0.39, 2.71); P = 0.96), CV death [RR: 0.78 (0.61, 1.01); P = 0.06], or all-cause mortality [RR: 0.85 (0.68, 1.06); P = 0.15]. Safety analyses revealed no significant differences in the risk of cough [RR: 0.63 (0.15, 2.72); P = 0.54], hypotension [RR: 1.68 (0.97, 2.91); P = 0.06], worsening renal function [RR: 0.51 (0.22, 1.21); P = 0.13], or hyperkalemia [RR: 0.59 (0.17, 2.01); P = 0.40].
CONCLUSION: Sacubitril/valsartan therapy significantly reduces MACE and HHF and improves LVEF in patients with STEMI, without increasing the risk of adverse safety outcomes. Future well-powered randomized trials are needed to confirm these results and support clinical guideline recommendations.
METHODS: PubMed and Cochrane databases were systematically searched from inception to July 2024 to identify randomized controlled trials (RCTs) comparing sacubitril/valsartan and ACEIs in patients with STEMI. Data were synthesized using a random-effects model to calculate risk ratios (RRs) and weighted mean differences (WMDs), each with 95% confidence intervals (CIs). A P-value < 0.05 was considered statistically significant.
RESULTS: A total of five RCTs comprising 4915 participants were included in the final analysis. Sacubitril/valsartan therapy was associated with a significant reduction in major adverse cardiovascular events (MACE) [RR: 0.66 (0.50, 0.86); P = 0.002] and hospitalizations for heart failure (HHF) [RR: 0.67 (0.49, 0.92); P = 0.01]. Treatment with sacubitril/valsartan also significantly improved left ventricular ejection fraction (LVEF) [WMD: 2.60 (1.53, 3.68); P < 0.00001] and reduced NT-proB-type natriuretic peptide (NT-proBNP) levels (WMD: -268.89 [-422.35, -115.42]; P = 0.0006). No significant differences were observed in the risk of recurrent myocardial infarction [RR: 1.02 (0.39, 2.71); P = 0.96), CV death [RR: 0.78 (0.61, 1.01); P = 0.06], or all-cause mortality [RR: 0.85 (0.68, 1.06); P = 0.15]. Safety analyses revealed no significant differences in the risk of cough [RR: 0.63 (0.15, 2.72); P = 0.54], hypotension [RR: 1.68 (0.97, 2.91); P = 0.06], worsening renal function [RR: 0.51 (0.22, 1.21); P = 0.13], or hyperkalemia [RR: 0.59 (0.17, 2.01); P = 0.40].
CONCLUSION: Sacubitril/valsartan therapy significantly reduces MACE and HHF and improves LVEF in patients with STEMI, without increasing the risk of adverse safety outcomes. Future well-powered randomized trials are needed to confirm these results and support clinical guideline recommendations.