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Angiotensin Receptor-Neprilysin Inhibition in Acute Myocardial Infarction.
- Source :
-
The New England journal of medicine [N Engl J Med] 2021 Nov 11; Vol. 385 (20), pp. 1845-1855. - Publication Year :
- 2021
-
Abstract
- Background: In patients with symptomatic heart failure, sacubitril-valsartan has been found to reduce the risk of hospitalization and death from cardiovascular causes more effectively than an angiotensin-converting-enzyme inhibitor. Trials comparing the effects of these drugs in patients with acute myocardial infarction have been lacking.<br />Methods: We randomly assigned patients with myocardial infarction complicated by a reduced left ventricular ejection fraction, pulmonary congestion, or both to receive either sacubitril-valsartan (97 mg of sacubitril and 103 mg of valsartan twice daily) or ramipril (5 mg twice daily) in addition to recommended therapy. The primary outcome was death from cardiovascular causes or incident heart failure (outpatient symptomatic heart failure or heart failure leading to hospitalization), whichever occurred first.<br />Results: A total of 5661 patients underwent randomization; 2830 were assigned to receive sacubitril-valsartan and 2831 to receive ramipril. Over a median of 22 months, a primary-outcome event occurred in 338 patients (11.9%) in the sacubitril-valsartan group and in 373 patients (13.2%) in the ramipril group (hazard ratio, 0.90; 95% confidence interval [CI], 0.78 to 1.04; P = 0.17). Death from cardiovascular causes or hospitalization for heart failure occurred in 308 patients (10.9%) in the sacubitril-valsartan group and in 335 patients (11.8%) in the ramipril group (hazard ratio, 0.91; 95% CI, 0.78 to 1.07); death from cardiovascular causes in 168 (5.9%) and 191 (6.7%), respectively (hazard ratio, 0.87; 95% CI, 0.71 to 1.08); and death from any cause in 213 (7.5%) and 242 (8.5%), respectively (hazard ratio, 0.88; 95% CI, 0.73 to 1.05). Treatment was discontinued because of an adverse event in 357 patients (12.6%) in the sacubitril-valsartan group and 379 patients (13.4%) in the ramipril group.<br />Conclusions: Sacubitril-valsartan was not associated with a significantly lower incidence of death from cardiovascular causes or incident heart failure than ramipril among patients with acute myocardial infarction. (Funded by Novartis; PARADISE-MI ClinicalTrials.gov number, NCT02924727.).<br /> (Copyright © 2021 Massachusetts Medical Society.)
- Subjects :
- Aged
Aminobutyrates adverse effects
Angiotensin Receptor Antagonists adverse effects
Angiotensin-Converting Enzyme Inhibitors adverse effects
Biphenyl Compounds adverse effects
Cardiovascular Diseases mortality
Double-Blind Method
Drug Combinations
Female
Hospitalization statistics & numerical data
Humans
Hypotension chemically induced
Male
Middle Aged
Myocardial Infarction complications
Myocardial Infarction mortality
Proportional Hazards Models
Ramipril adverse effects
Stroke Volume
Valsartan adverse effects
Ventricular Dysfunction, Left etiology
Aminobutyrates therapeutic use
Angiotensin Receptor Antagonists therapeutic use
Angiotensin-Converting Enzyme Inhibitors therapeutic use
Biphenyl Compounds therapeutic use
Heart Failure prevention & control
Myocardial Infarction drug therapy
Ramipril therapeutic use
Valsartan therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1533-4406
- Volume :
- 385
- Issue :
- 20
- Database :
- MEDLINE
- Journal :
- The New England journal of medicine
- Publication Type :
- Academic Journal
- Accession number :
- 34758252
- Full Text :
- https://doi.org/10.1056/NEJMoa2104508