Mogensen Ulrik M, Køber Lars, Kristensen Søren L, Jhund Pardeep S, Gong Jianjian, Lefkowitz Martin P, Rizkala Adel R, Rouleau Jean L, Shi Victor C, Swedberg Karl, Zile Michael R, Solomon Scott D, Packer Milton, McMurray John J V
BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK; Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
Am Heart J. 2017 Jun;188:35-41. doi: 10.1016/j.ahj.2017.02.034. Epub 2017 Mar 14.
Angiotensin converting enzyme inhibitors (ACE-I), are beneficial both in heart failure with reduced ejection fraction (HF-REF) and after myocardial infarction (MI). We examined the effects of the angiotensin-receptor neprilysin inhibitor sacubitril/valsartan, compared with the ACE-I enalapril, on coronary outcomes in PARADIGM-HF.
We examined the effect of sacubitril/valsartan compared with enalapril on the following outcomes: i) the primary composite endpoint of cardiovascular (CV) death or HF hospitalization, ii) a pre-defined broader composite including, in addition, MI, stroke, and resuscitated sudden death, and iii) a post hoc coronary composite of CV-death, non-fatal MI, angina hospitalization or coronary revascularization. At baseline, of 8399 patients, 3634 (43.3%) had a prior MI and 4796 (57.1%) had a history of any coronary artery disease. Among all patients, compared with enalapril, sacubitril/valsartan reduced the risk of the primary outcome (HR 0.80 [0.73-0.87], P<.001), the broader composite (HR 0.83 [0.76-0.90], P<.001) and the coronary composite (HR 0.83 [0.75-0.92], P<.001). Although each of the components of the coronary composite occurred less frequently in the sacubitril/valsartan group, compared with the enalapril group, only CV death was reduced significantly.
Compared with enalapril, sacubitril/valsartan reduced the risk of both the primary endpoint and a coronary composite outcome in PARADIGM-HF. Additional studies on the effect of sacubitril/valsartan on atherothrombotic outcomes in high-risk patients are merited.
血管紧张素转换酶抑制剂（ACE-I）对射血分数降低的心力衰竭（HF-REF）患者和心肌梗死（MI）后患者均有益。我们在PARADIGM-HF研究中，比较了血管紧张素受体脑啡肽酶抑制剂沙库巴曲缬沙坦与ACE-I依那普利对冠状动脉结局的影响。
我们比较了沙库巴曲缬沙坦与依那普利对以下结局的影响：i）心血管（CV）死亡或HF住院的主要复合终点；ii）一个预先定义的更广泛的复合终点，此外还包括MI、中风和复苏的心脏骤停；iii）一个事后分析的冠状动脉复合终点，包括CV死亡、非致命性MI、心绞痛住院或冠状动脉血运重建。在基线时，8399例患者中，3634例（43.3%）有既往MI史，4796例（57.1%）有任何冠状动脉疾病史。在所有患者中，与依那普利相比，沙库巴曲缬沙坦降低了主要结局的风险（HR 0.80 [0.73-0.87]，P<0.001）、更广泛复合终点的风险（HR 0.83 [0.76-0.90]，P<0.001）和冠状动脉复合终点的风险（HR 0.83 [0.75-0.92]，P<0.001）。尽管与依那普利组相比，冠状动脉复合终点的各个组成部分在沙库巴曲缬沙坦组中发生的频率均较低，但只有CV死亡显著降低。
与依那普利相比，沙库巴曲缬沙坦降低了PARADIGM-HF研究中主要终点和冠状动脉复合结局的风险。值得对沙库巴曲缬沙坦对高危患者动脉粥样硬化血栓形成结局的影响进行更多研究。
