Angiotensin Receptor-Neprilysin Inhibition in Acute Myocardial Infarction
Por:
Pfeffer, MA, Claggett, B, Lewis, EF, Granger, CB, Kober, L, Maggioni, AP, Mann, DL, McMurray, JJV, Rouleau, JL, Solomon, SD, Steg, PG, Berwanger, O, Cikes, M, De Pasquale, CG, East, C, Fernandez, A, Jering, K, Landmesser, U, Mehran, R, Merkely, B, Mody, FV, Petrie, MC, Petrov, I, Schou, M, Senni, M, Sim, D, van der Meer, P, Lefkowitz, M, Zhou, Y, Gong, J, Braunwald, E, Sionis A., PARADISE-MI Invest & Comm
Publicada:
11 nov 2021
Resumen:
Sacubitril-Valsartan in Acute Myocardial Infarction In a randomized trial, 5661 patients with acute myocardial infarction and a reduced left ventricular ejection fraction, pulmonary congestion, or both were assigned to receive either sacubitril-valsartan or ramipril. At a median of 22 months, there was no significant difference between the two groups in the incidence of death from cardiovascular causes or incident heart failure.
Background In patients with symptomatic heart failure, sacubitril-valsartan has been found to reduce the risk of hospitalization and death from cardiovascular causes more effectively than an angiotensin-converting-enzyme inhibitor. Trials comparing the effects of these drugs in patients with acute myocardial infarction have been lacking. Methods We randomly assigned patients with myocardial infarction complicated by a reduced left ventricular ejection fraction, pulmonary congestion, or both to receive either sacubitril-valsartan (97 mg of sacubitril and 103 mg of valsartan twice daily) or ramipril (5 mg twice daily) in addition to recommended therapy. The primary outcome was death from cardiovascular causes or incident heart failure (outpatient symptomatic heart failure or heart failure leading to hospitalization), whichever occurred first. Results A total of 5661 patients underwent randomization; 2830 were assigned to receive sacubitril-valsartan and 2831 to receive ramipril. Over a median of 22 months, a primary-outcome event occurred in 338 patients (11.9%) in the sacubitril-valsartan group and in 373 patients (13.2%) in the ramipril group (hazard ratio, 0.90; 95% confidence interval [CI], 0.78 to 1.04; P=0.17). Death from cardiovascular causes or hospitalization for heart failure occurred in 308 patients (10.9%) in the sacubitril-valsartan group and in 335 patients (11.8%) in the ramipril group (hazard ratio, 0.91; 95% CI, 0.78 to 1.07); death from cardiovascular causes in 168 (5.9%) and 191 (6.7%), respectively (hazard ratio, 0.87; 95% CI, 0.71 to 1.08); and death from any cause in 213 (7.5%) and 242 (8.5%), respectively (hazard ratio, 0.88; 95% CI, 0.73 to 1.05). Treatment was discontinued because of an adverse event in 357 patients (12.6%) in the sacubitril-valsartan group and 379 patients (13.4%) in the ramipril group. Conclusions Sacubitril-valsartan was not associated with a significantly lower incidence of death from cardiovascular causes or incident heart failure than ramipril among patients with acute myocardial infarction. (Funded by Novartis; PARADISE-MI ClinicalTrials.gov number, .)
Filiaciones:
Pfeffer, MA:
Brigham & Womens Hosp, Cardiovasc Div, 75 Francis St, Boston, MA 02115 USA
Claggett, B:
Brigham & Womens Hosp, Cardiovasc Div, 75 Francis St, Boston, MA 02115 USA
Lewis, EF:
Stanford Univ, Sch Med, Div Cardiovasc Med, Palo Alto, CA 94304 USA
Granger, CB:
Duke Univ, Med Ctr, Durham, NC USA
Kober, L:
Univ Copenhagen, Rigshosp, Blegdamsvej, Copenhagen, Denmark
Maggioni, AP:
Natl Assoc Hosp Cardiologists Res Ctr, Florence, Italy
Mann, DL:
Washington Univ, Sch Med, St Louis, MO USA
McMurray, JJV:
Univ Glasgow, British Heart Fdn Cardiovasc Res Ctr, Glasgow, Lanark, Scotland
Rouleau, JL:
Univ Montreal, Montreal Heart Inst, Montreal, PQ, Canada
Solomon, SD:
Brigham & Womens Hosp, Cardiovasc Div, 75 Francis St, Boston, MA 02115 USA
Steg, PG:
Univ Paris, AP HP, French Alliance Cardiovasc Trials, Paris, France
INSERM, Unite 1148, Paris, France
Berwanger, O:
Hosp Israelita Albert Einstein, Acad Res Org, Sao Paulo, Brazil
Cikes, M:
Univ Zagreb, Sch Med, Univ Hosp Ctr Zagreb, Dept Cardiovasc Dis, Zagreb, Croatia
De Pasquale, CG:
Flinders Med Ctr, Dept Cardiovasc Med, Adelaide, SA, Australia
East, C:
Baylor Scott & White Heart & Vasc Hosp, Baylor Soltero CV Res Ctr, Dallas, TX USA
Fernandez, A:
Sanatorio Modelo Quilmes, Serv Cardiol, Quilmes, Argentina
Jering, K:
Brigham & Womens Hosp, Cardiovasc Div, 75 Francis St, Boston, MA 02115 USA
Landmesser, U:
Charite Univ Med Berlin, Berlin Inst Hlth, German Ctr Cardiovasc Res Partner Site Berlin, Dept Cardiol, Berlin, Germany
Mehran, R:
Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY 10029 USA
Merkely, B:
Semmelweis Univ, Heart & Vasc Ctr, Budapest, Hungary
Mody, FV:
Univ Calif Los Angeles, Dept Vet Affairs Greater Los Angeles, Heart Failure & Prevent Cardiol Programs, Los Angeles, CA USA
Petrie, MC:
Univ Glasgow, British Heart Fdn Cardiovasc Res Ctr, Glasgow, Lanark, Scotland
Petrov, I:
Acibadem City Clin Cardiovasc Ctr, Sofia, Bulgaria
Schou, M:
Herlev Gentofte Univ Hosp, Dept Cardiol, Copenhagen, Denmark
Senni, M:
Hosp Papa Giovanni XXIII, Cardiovasc Dept, Bergamo, Italy
Sim, D:
Natl Heart Ctr Singapore, Singapore, Singapore
van der Meer, P:
Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands
Lefkowitz, M:
Novartis, E Hanover, NJ USA
Zhou, Y:
Novartis, E Hanover, NJ USA
Gong, J:
Novartis, E Hanover, NJ USA
Braunwald, E:
Brigham & Womens Hosp, Cardiovasc Div, 75 Francis St, Boston, MA 02115 USA
Brigham & Womens Hosp, Cardiovasc Div, Thrombolysis Myocardial Infarct Study Grp, 75 Francis St, Boston, MA 02115 USA
Sionis A.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Green Published
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