Early Sacubitril/valsartan Therapy Reduces Ventricular Remodeling and Cardiac Events in Patients with Acute Anterior Myocardial Infarction.

Abstract

Purpose: To compare the effects of early angiotensin receptor-neprilysin inhibitor (ARNI) versus angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) therapy on left ventricular remodeling and heart failure progression in patients with acute anterior wall myocardial infarction.

Methods: Patients were stratified by treatment into ARNI (n=97) and ACEI/ARB (n=71) groups. Baseline characteristics, cardiac ultrasound data (baseline, 0-3 months, 6-12 months), and major adverse cardiac events (MACEs) were analyzed.

Results: The ARNI group demonstrated significantly greater improvements in left ventricular end-diastolic diameter and relative wall thickness versus the ACEI/ARB group. Subgroup analyses (target-dose achievers, emergency reperfusion recipients, left ventricular ejection fraction ≥50% patients) consistently showed better improvements with ARNI. ARNI therapy also significantly reduced MACEs risk (HR = 0.392, 95% CI: 0.194-0.791, P = 0.009).

Conclusion: Compared with ACEI/ARB, ARNI demonstrated enhanced preservation of cardiac function, attenuation of adverse ventricular remodeling, and maintenance of ventricular geometry following myocardial infarction. Additionally, ARNI was associated with a reduction in major adverse cardiac events and improved survival outcomes.