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Sacubitril/valsartan compared to ramipril in high‐risk post‐myocardial infarction patients stratified according to use of mineralocorticoid receptor antagonists: Insight from the PARADISE MI trial.

Authors :
Schou, Morten
Claggett, Brian
Miao, Zi Michael
Fernandez, Alberto
Filippatos, Gerasimos
Granger, Christopher
Jering, Karola
Maggioni, Aldo P.
McCausland, Finnian
Villota, Julio Nuñez
Rouleau, Jean‐Lucien
Mody, Freny Vaghaiwalla
van der Meer, Peter
Vinereanu, Dragos
McGrath, Martina
Zhou, Yinong
Mann, Douglas L.
Solomon, Scott D.
Steg, Philippe Gabriel
Braunwald, Eugene
Source :
European Journal of Heart Failure. Jan2024, Vol. 26 Issue 1, p130-139. 10p.
Publication Year :
2024

Abstract

Aim: It is unknown whether safety and clinical endpoints by use of sacubitril/valsartan (an angiotensin receptor–neprilysin inhibitor [ARNI]) are affected by mineralocorticoid receptor antagonists (MRA) in high‐risk myocardial infarction (MI) patients. The aim of this study was to examine whether MRA modifies safety and clinical endpoints by use of sacubitril/valsartan in patients with a MI and left ventricular systolic dysfunction (LVSD) and/or pulmonary congestion. Methods and results: Patients (n = 5661) included in the PARADISE MI trial (Prospective ARNI vs. ACE Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events After MI) were stratified according to MRA. Primary outcomes in this substudy were worsening heart failure or cardiovascular death. Safety was defined as symptomatic hypotension, hyperkalaemia >5.5 mmol/L, or permanent drug discontinuation. A total of 2338 patients (41%) were treated with MRA. Safety of ARNI compared to ramipril was not altered significantly by ± MRA, and both groups had similar increase in symptomatic hypotension with ARNI. In patients taking MRA, the risk of hyperkalaemia or permanent drug discontinuation was not significantly altered by ARNI (p > 0.05 for all comparisons). The effect of ARNI compared with ramipril was similar in those who were and were not taking MRA (hazard ratio [HR]MRA 0.96, 95% confidence interval [CI] 0.77–1.19 and HRMRA– 0.87, 95% CI 0.71–1.05, for the primary endpoint; p = 0.51 for interaction [Clinical Endpoint Committee adjudicated]); similar findings were observed if investigator‐reported endpoints were evaluated (p = 0.61 for interaction). Conclusions: Use of a MRA did not modify safety or clinical endpoints related to initiation of ARNI compared to ramipril in the post‐MI setting in patients with LVSD and/or congestion. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
13889842
Volume :
26
Issue :
1
Database :
Academic Search Index
Journal :
European Journal of Heart Failure
Publication Type :
Academic Journal
Accession number :
175503435
Full Text :
https://doi.org/10.1002/ejhf.3079