萨库比特里尔/瓦尔萨坦在患有失偿心力衰竭住院的患者中
David A Morrow1, Eric J Velazquez2, Akshay S Desai3
1TIMI Study Group, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Journal of the American College of Cardiology
|March 20, 2024
概括
在因心力衰竭恶化而住院的患者中,萨库比特里尔/瓦尔萨坦显著降低了NT-proBNP和心血管事件. 在左心室射出分数 (EF) 的广泛范围内观察到的好处高达60%.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 临床试验 临床试验
背景情况:
- 在住院心力衰竭 (HF) 患者的左心室喷射小部分 (EF) 谱中,萨库比特里尔/瓦尔萨坦的有效性和安全性以前未被描述.
- 心力衰竭管理需要了解不同EF范围的治疗效果.
研究的目的:
- 将PIONEER-HF和PARAGLIDE-HF随机试验的数据汇总起来,以评估因心力衰竭 (WHF) 恶化而住院的患者在EF频谱中sacubitril/valsartan的治疗效果.
- 评估萨库比特里尔/瓦尔沙坦对N端B型亲尿素 (NT-proBNP) 水平和临床结果的影响.
主要方法:
- 两项双盲随机试验 (PIONEER-HF和PARAGLIDE-HF) 的综合分析,将萨库比特里尔/瓦尔萨坦与对照疗法 (伊纳拉普利尔或瓦尔萨坦) 进行比较.
- 患者在住院治疗HF期间或在WHF事件发生后30天内被录取.
- 主要终点是NT-proBNP的时间平均比例变化;通过随访分析临床终点.
主要成果:
- 综合分析包括1347名患者,EF中位数为30%.
- 与对照疗法相比,萨库比特里尔/瓦尔沙坦在NT-proBNP中的降低幅度比对照疗法大24% (P < 0.0001).
- 心血管死亡或HF住院减少了30% (HR:0.70;P = 0.0077),在EF ≤60%之间一致. 症状性低血压的风险增加 (RR: 1.35).
结论:
- 在WHF后稳定的患者中,与对照疗法相比,萨库比特里尔/瓦尔萨坦显著降低了NT-proBNP,改善了临床结果.
- 这些好处在EF ≤60%的整个频谱中尤其明显.
- 萨库比特里尔/瓦尔萨坦是广泛的EF范围内的住院HF患者的有效治疗选择.
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