Why the study?
Although ACEIs remain the cornerstone treatment for STEMI, ARNIs may offer better outcomes, prompting a comparison of their efficacy and safety.
Do angiotensin-receptor neprilysin inhibitors (ARNIs) reduce major adverse cardiovascular events compared to ACE inhibitors in patients with STEMI?
Do angiotensin-receptor neprilysin inhibitors (ARNIs) reduce major adverse cardiovascular events compared to ACE inhibitors in patients with STEMI?
In patients with STEMI, ARNI therapy significantly reduces MACE and heart failure hospitalizations while improving LVEF compared to ACE inhibitors, though with an increased risk of hypotension.
Answers are grounded in this paper and cite their sources.
May support ARNI preference over ACEIs post-STEMI with hypotension monitoring; extends randomized HF evidence to acute MI.
Background ST-segment elevation myocardial infarction (STEMI) is responsible for high morbidity and mortality rates globally. Although the use of angiotensin-converting enzyme inhibitors (ACEIs) remains the cornerstone treatment for patients with STEMI, the use of angiotensin-receptor neprilysin inhibitors (ARNIs) may offer better outcomes than ACEIs. This meta-analysis compares the efficacy and safety of ARNIs versus ACEIs in patients with STEMI.Methods Randomized controlled trials (RCTs) were pooled from PubMed and Cochrane databases. A random-effects model calculated risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs).Results Five trials (n = 4,915) were included. ARNIs significantly reduced major adverse cardiovascular events (MACE) (RR: 0.66, 95% CI [0.50, 0.86]; p = 0.002) and hospitalizations for heart failure (HHF) (RR: 0.67, 95% CI [0.49, 0.92]; p = 0.01). ARNIs also improved left ventricular ejection fraction (LVEF) (WMD: 2.60, 95% CI[1.53, 3.68]; p < 0.00001) and lowered NT-proBNP levels (WMD: −268.89, 95% CI[−422.35, −115.42]; p = 0.0006). No significant differences were observed in recurrent myocardial infarction, cardiovascular death, or safety outcomes – except for hypotension, which was significantly more common with ARNI use. Conclusions ARNI therapy reduces MACE, HHF, and NT-proBNP levels and improves LVEF in patients with STEMI without increasing safety risks, except for hypotension. Further RCTs are needed to confirm these findings.
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Ahmed et al. (2025) studied this question.
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