Early initiation of Sacubitril/Valsartan in patients after acute myocardial infarction reduced the risk of major adverse cardiac events compared to ACEIs (RR 0.61; 95% CI 0.46-0.82; P=.001).
Meta-Analysis (n=6,154)
Does early initiation of Sacubitril/Valsartan reduce major adverse cardiac events and improve LVEF compared to ACEIs in patients after acute myocardial infarction?
Early initiation of sacubitril/valsartan in patients after acute myocardial infarction improves LVEF and reduces MACE compared to ACE inhibitors, but does not significantly reduce cardiac death or HF hospitalization.
Effect estimate: RR 0.61 (95% CI 0.46-0.82)
p-value: p=.001
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.
Zhao et al. (Tue,) conducted a meta-analysis in acute myocardial infarction (n=6,154). Sacubitril/Valsartan vs. angiotensin-converting enzyme inhibitors (ACEIs) was evaluated on major adverse cardiac events (RR 0.61, 95% CI 0.46-0.82, p=.001). Early initiation of Sacubitril/Valsartan in patients after acute myocardial infarction reduced the risk of major adverse cardiac events compared to ACEIs (RR 0.61; 95% CI 0.46-0.82; P=.001).