在患有STEMI与NSTEMI的患者中抑制angiotensin受体-neprilysin抑制
Douglas L Mann1, Johny Nicolas2, Brian Claggett3
1Washington University School of Medicine, St Louis, Missouri, USA.
Journal of the American College of Cardiology
|February 28, 2024
概括
在急性心肌梗塞 (AMI) 后,萨库比特里尔/瓦尔萨坦并没有显著减少心血管死亡或心力衰竭,无论是ST升高 (STEMI) 还是非ST升高 (NSTEMI). 拉米普利在STEMI和NSTEMI患者组中显示出类似的疗效.
科学领域:
- 心脏病学 心脏病学
- 临床试验 临床试验
- 药理学 药理学是指药理学的学科.
背景情况:
- 患有急性心肌梗塞 (AMI) 的患者,包括STEMI和NSTEMI,面临心力衰竭 (HF),冠状动脉复发事件和死亡的高风险.
- ангиотензин转化酶 (ACE) 抑制剂是已建立的治疗方法,可降低AMI患者心血管事件风险.
研究的目的:
- 为了比较sacubitril/valsartan (angiotensin受体阻塞和 neprilysin抑制) 与ramipril (ACE抑制剂) 在减少AMI后患者心血管事件的疗效.
- 具体分析AMI类型 (STEMI与NSTEMI) 对治疗结果的影响.
主要方法:
- 在PARADISE-MI试验中,随机分配了患有AMI,左心室功能障碍和/或肺堵塞的患者,接受sacubitril/valsartan或ramipril.
- 主要终点是心血管死亡或心力衰竭. 这种分析预先根据AMI类型 (STEMI与NSTEMI) 进行了预先规定的分层.
主要成果:
- 在5,661名患者中,75.8%患有STEMI. 与STEMI患者相比,NSTEMI患者年轻,风险因素较少.
- 主要结局风险在NSTEMI患者和STEMI患者中略高 (调整HR:1.19;P=0.05).
- 在STEMI (HR:0.87;P=0.13) 和NSTEMI (HR:0.97;P=0.80) 两组中,萨库比特里尔/瓦尔萨坦和拉米普利的初级复合结局率相似,AMI类型没有显著的相互作用 (P=0.53).
结论:
- 与拉米普利尔相比,萨库比特里尔/瓦尔萨坦在AMI和左心室功能障碍患者中没有显著降低心血管死亡或心力衰竭的风险.
- 这些发现在STEMI和NSTEMI患者亚组中一致,表明基于AMI类型没有差异性益处.
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