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SAcubitril/valsartan versus ramipril in patients with ST-segment Elevation Myocardial Infarction and cardiogenic

Ahmed Rezq1,2, Marwan Saad1,3, Mostafa El Nozahi1

  • 1Department of Cardiology, Ain Shams University Cairo, Egypt.

American Journal of Cardiovascular Disease
|February 4, 2022
PubMed

Insights

Sacubitril/valsartan showed reduced heart failure hospitalizations compared to ramipril in STEMI patients with cardiogenic shock. Further trials are needed to confirm long-term benefits of sacubitril/valsartan.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • ST-elevation myocardial infarction (STEMI) with cardiogenic shock has high mortality.
  • Optimal medical therapy post-STEMI complicated by cardiogenic shock requires further investigation.

Purpose of the Study:

  • To compare the safety and efficacy of sacubitril/valsartan against ramipril in STEMI patients experiencing cardiogenic shock.
  • To evaluate major adverse cardiac events (MACE) and clinical outcomes in this high-risk population.

Main Methods:

  • Randomized controlled trial involving 100 patients with STEMI and cardiogenic shock post-primary percutaneous coronary intervention (PPCI).
  • Patients were randomized to receive either sacubitril/valsartan or ramipril after clinical stabilization.
  • Primary outcome: MACE at 30 days and 6 months. Secondary outcomes: recurrent shock, vasoactive medication use, acute kidney injury (AKI), death, heart failure hospitalization, myocardial infarction, and stroke.

Main Results:

  • No significant difference in primary outcome (MACE) at 30 days and 6 months between sacubitril/valsartan and ramipril groups.
  • No difference in in-hospital or 30-day clinical outcomes.
  • At 6 months, sacubitril/valsartan group showed significantly lower hospitalization for heart failure (HF) compared to ramipril (18% vs 38%, P=0.044).

Conclusions:

  • Sacubitril/valsartan may offer improved clinical outcomes, specifically reduced HF hospitalizations, at 6 months in STEMI patients with cardiogenic shock compared to ramipril.
  • Larger randomized controlled trials with extended follow-up are warranted to validate these findings.
Abstract

Keywords:
Entresto®STEMISacubitril/valsartancardiogenic shock

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