ARN Inhibitor Reduces Major CV Events in AMI

TOPLINE:

In patients with heart failure (HF) due to acute myocardial infarction (AMI), angiotensin receptor–neprilysin (ARN) inhibitors lower the risk for cardiovascular (CV) events, reduce HF rehospitalizations, and improve cardiac remodeling.

METHODOLOGY:

• A meta-analysis of nine studies (eight randomized controlled trials and one echo substudy) conducted until February 2024 included 6597 patients with AMI and HF with reduced ejection fraction.
• Of these patients, 3297 received ARN inhibitors and 3300 received standard treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, with a mean follow-up of 6 months.
• The primary outcome assessed was major cardiovascular events (MACEs), and the secondary outcomes included rehospitalization for HF, all-cause mortality, nonfatal myocardial infarction, and cardiac death.

TAKEAWAY:

• The ARN inhibitor–treated group (sacubitril/valsartan) had a significantly lower risk for MACEs (odds ratio [OR], 0.45; P<.0001 and="" fewer="" rehospitalizations="" for="" hf="">P .0001) than the standard treatment group.
• The rates of all-cause mortality (OR, 0.88; P =.18) and cardiac death (OR, 0.89; P =.28) were similar in both the ARN inhibitor–treated group and the standard treatment group.
• Left ventricle volumes were significantly lower in the ARN inhibitor group than in the standard treatment group (left ventricular end-diastolic volume: mean difference [MD], 11.48 mL; P<.0001 left="" ventricular="" end-systolic="" volume:="" md="" ml="">P =.0009), along with a significant change in the left ventricular ejection fraction (MD, 3.07; P<.0001>
• The ARN inhibitor–treated group had a higher incidence of iatrogenic hypotensive events than the standard treatment group (OR, 1.42; P .00001), while N-terminal pro-brain natriuretic peptide levels were similar in both the ARN inhibitor–treated group and the standard treatment group.

IN PRACTICE:

“In patients with acute myocardial infarction–related heart failure, the in-hospital administration of ARNis [angiotensin receptor–neprilysin inhibitors] was associated with a reduced risk of major cardiovascular events and rehospitalizations for heart failure, as well as cardiac remodelling, but higher rates of hypotensive events compared with standard therapy,” the authors wrote.

SOURCE:

The study was led by Massimo Mancone, Department of Internal Clinical, Anesthesiological, and Cardiovascular Sciences, La Sapienza University of Rome, Rome, Italy, and was published online on October 29, 2024, in ESC Heart Failure.

LIMITATIONS:

The meta-analysis had several limitations, including the fact that most randomized controlled trials were unblinded, potentially introducing bias. The findings were constrained by the geographic scope of the studies, limiting their generalizability. Other limitations included insufficient data on dosages, heterogeneity in outcome analyses, and the inability to perform subgroup analyses according to age and treatment duration.

DISCLOSURES:

The authors did not disclose any funding source or conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.