TY  - JOUR
ID  - enlighten285338
UR  - https://eprints.gla.ac.uk/285338/
IS  - 23
A1  - Mehran, Roxana
A1  - Steg, Philippe Gabriel
A1  - Pfeffer, Marc A.
A1  - Jering, Karola
A1  - Claggett, Brian
A1  - Lewis, Eldrin F.
A1  - Granger, Christopher
A1  - K�ber, Lars
A1  - Maggioni, Aldo
A1  - Mann, Douglas L.
A1  - McMurray, John J.V.
A1  - Rouleau, Jean-Lucien
A1  - Solomon, Scott D.
A1  - Ducrocq, Gregory
A1  - Berwanger, Otavio
A1  - De Pasquale, Carmine G.
A1  - Landmesser, Ulf
A1  - Petrie, Mark
A1  - Leng, David Sim Kheng
A1  - van der Meer, Peter
A1  - Lefkowitz, Martin
A1  - Zhou, Yinong
A1  - Braunwald, Eugene
N2  - Background: In patients who survive an acute myocardial infarction (AMI), angiotensin-converting enzyme inhibitors decrease the risk of subsequent major cardiovascular events. Whether angiotensin-receptor blockade and neprilysin inhibition with sacubitril/valsartan reduce major coronary events more effectively than angiotensin-converting enzyme inhibitors in high-risk patients with recent AMI remains unknown. We aimed to compare the effects of sacubitril/valsartan on coronary outcomes in patients with AMI. Methods: We conducted a prespecified analysis of the PARADISE-MI trial (Prospective ARNI vs ACE Inhibitors Trial to Determine Superiority in Reducing Heart Failure Events After MI), which compared sacubitril/valsartan (97/103 mg twice daily) with ramipril (5 mg twice daily) for reducing heart failure events after myocardial infarction in 5661 patients with AMI complicated by left ventricular systolic dysfunction, pulmonary congestion, or both. In the present analysis, the prespecified composite coronary outcome was the first occurrence of death from coronary heart disease, nonfatal myocardial infarction, hospitalization for angina, or postrandomization coronary revascularization. Results: Patients were randomly assigned at a median of 4.4 [3.0?5.8] days after index AMI (ST-segment?elevation myocardial infarction 76%, non?ST-segment?elevation myocardial infarction 24%), by which time 89% of patients had undergone coronary reperfusion. Compared with ramipril, sacubitril/valsartan decreased the risk of coronary outcomes (hazard ratio, 0.86 [95% CI, 0.74?0.99], P =0.04) over a median follow-up of 22 months. Rates of the components of the composite outcomes were lower in patients on sacubitril/valsartan but were not individually significantly different. Conclusions: In survivors of an AMI with left ventricular systolic dysfunction and pulmonary congestion, sacubitril/valsartan?compared with ramipril?reduced the risk of a prespecified major coronary composite outcome. Dedicated studies are necessary to confirm this finding and elucidate its mechanism. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02924727.
VL  - 146
TI  - The effects of angiotensin receptor-neprilysin inhibition on major coronary events in patients with acute myocardial infarction: insights from the PARADISE-MI trial
AV  - public
EP  - 1757
N1  - This work was funded by Novartis.
Y1  - 2022/12/06/
PB  - American Heart Association
JF  - Circulation
SN  - 0009-7322
SP  - 1749
ER  -