ARNI versus ACEI/ARB in Reducing Cardiovascular Outcomes after Myocardial Infarction

Area of Science:

• Cardiology
• Pharmacology
• Clinical Research

Background:

• Acute myocardial infarction (AMI) remains a leading cause of cardiovascular mortality.
• Standard therapies like angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) are crucial, but further improvements in outcomes are sought.
• Angiotensin receptor-neprilysin inhibitor (ARNI) represents a newer therapeutic class with potential benefits in cardiovascular diseases.

Purpose of the Study:

• To compare the long-term cardiovascular efficacy of ARNI therapy versus ACEI/ARB therapy in patients following acute myocardial infarction.
• To identify specific patient subgroups who may derive maximal benefit from ARNI treatment post-AMI.

Main Methods:

• Retrospective analysis of 7556 AMI patients from January 2016 to December 2020.
• Propensity score matching was employed to create comparable groups for ARNI, ACEI, and ARB treatments.
• Key factors for matching included age, sex, blood pressure, kidney function, left ventricular ejection fraction (LVEF), and concomitant cardiovascular medications.

Main Results:

• ARNI therapy was associated with significantly lower rates of composite cardiovascular outcomes compared to both ACEI (HR 0.51, P=0.02) and ARB (HR 0.47, P=0.02).
• ARNI use also led to lower rates of cardiovascular death versus ACEI (HR 0.37, P=0.01) and ARB (HR 0.41, P=0.04).
• Subgroup analyses revealed enhanced benefits of ARNI in patients with LVEF ≤40% and those aged ≤60 years.

Conclusions:

• ARNI therapy demonstrates superior efficacy over ACEI/ARB in mitigating long-term adverse cardiovascular events after AMI.
• Patients with reduced LVEF (≤40%) and younger patients (≤60 years) appear to benefit most from ARNI treatment.
• These findings support the consideration of ARNI therapy in specific AMI patient populations for improved cardiovascular outcomes.