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Updated: Nov 9, 2025

Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
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Prospective ARNI vs. ACE inhibitor trial to DetermIne Superiority in reducing heart failure Events after Myocardial

Karola S Jering1, Brian Claggett1, Marc A Pfeffer1

  • 1Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.

European Journal of Heart Failure
|April 13, 2021
PubMed

Insights

Sacubitril/valsartan may prevent heart failure and reduce cardiovascular death after high-risk myocardial infarction compared to ACE inhibitors. The PARADISE-MI trial investigated this in 5669 patients, with results pending.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Patients surviving acute myocardial infarction (AMI) face risks of heart failure (HF) and death.
  • Sacubitril/valsartan is effective for chronic HF, but its role post-AMI is under investigation.

Purpose of the Study:

  • To evaluate if sacubitril/valsartan prevents HF and reduces cardiovascular death post-high-risk AMI compared to an ACE inhibitor.
  • To describe the design and baseline characteristics of the PARADISE-MI trial.

Main Methods:

  • The multinational, double-blind PARADISE-MI trial randomized 5669 high-risk AMI patients to sacubitril/valsartan or ramipril.
  • Inclusion criteria involved recent AMI, specific LVEF, and additional risk factors for HF or death.
  • The study targeted 708 primary endpoints of cardiovascular death, HF hospitalization, or outpatient HF development.

Main Results:

  • Enrollment included 5669 patients, with a mean age of 64 years; 24% were women.
  • Most patients (76%) had ST-elevation myocardial infarction, with 88% undergoing PCI.
  • Mean LVEF was 37%, and 58% had Killip class ≥II.

Conclusions:

  • Baseline therapies reflect contemporary evidence-based care.
  • The PARADISE-MI trial is poised to determine the efficacy of sacubitril/valsartan versus ACE inhibitors in preventing HF and cardiovascular death post-AMI.
Abstract

Keywords:
Acute myocardial infarctionAngiotensin receptor-neprilysin inhibitorAngiotensin-converting enzyme inhibitorHeart failureSacubitril/valsartan

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