Cardiovascular Department, First Affiliated Hospital of Xi'an Jiaotong University, Yanta West 237, Xi'an, 710061, China.
Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi'an, China.
ESC Heart Fail. 2021 Dec;8(6):4607-4616. doi: 10.1002/ehf2.13644. Epub 2021 Oct 19.
This study aimed to compare the efficacy of angiotensin receptor-neprilysin inhibitor (ARNI) therapy with angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) therapy for cardiovascular outcomes in patients with acute myocardial infarction (AMI).
Data were collected from the Biobank of the First Affiliated Hospital of Xi'an Jiaotong University between January 2016 and December 2020. A total of 7556 AMI patients were screened for eligibility. Propensity score matching based on age, sex, blood pressure, kidney function, baseline left ventricular ejection fraction (LVEF), and cardiovascular medication were conducted, resulting in 291 patients with AMI being assigned to ARNI, ACEI, and ARB group, respectively. Patients receiving ARNI had significantly lower rates of the composite cardiovascular outcome than ACEI {hazard ratio [HR] 0.51, [95% confidence interval (CI), 0.27-0.95], P = 0.02}, and ARB users [HR 0.47, (95%CI, 0.24-0.90), P = 0.02]. Patients receiving ARNI showed lower rates of cardiovascular death than ACEI [HR 0.37, (95%CI, 0.18-0.79), P = 0.01] and ARB users [HR 0.41, (95%CI, 0.18-0.95), P = 0.04]. Subgroup analysis indicated that patients with LVEF no more than 40% tend to benefit more from ARNI as compared with ACEI [HR 0.30, (95%CI, 0.11-0.86), P = 0.01] or ARB [HR 0.21, (95%CI, 0.04-1.1), P = 0.05]. Patients aged no more than 60 years exhibited reduced composite endpoints [HR for ARNI vs. ARB: 0.11, (95%CI, 0.03-0.46), P = 0.002].
In patients with AMI, ARNI was superior to ACEI/ARB in reducing the long-term adverse cardiovascular outcomes. Subgroup analysis further indicates that ARNI is more likely to benefit patients with LVEF less than 40% and aged less than 60 years.
本研究旨在比较血管紧张素受体-脑啡肽酶抑制剂（ARNI）与血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（ACEI/ARB）治疗急性心肌梗死（AMI）患者心血管结局的疗效。
数据来自西安交通大学第一附属医院的生物库，收集时间为 2016 年 1 月至 2020 年 12 月。共筛选出 7556 例 AMI 患者，符合条件。基于年龄、性别、血压、肾功能、基线左心室射血分数（LVEF）和心血管药物进行倾向评分匹配，结果 291 例 AMI 患者分别被分配到 ARNI、ACEI 和 ARB 组。与 ACEI 相比，接受 ARNI 治疗的患者复合心血管结局的发生率显著降低[风险比（HR）0.51，（95%置信区间（CI），0.27-0.95），P=0.02]，与 ARB 使用者相比[HR 0.47，（95%CI，0.24-0.90），P=0.02]。接受 ARNI 治疗的患者心血管死亡发生率低于 ACEI [HR 0.37，（95%CI，0.18-0.79），P=0.01]和 ARB 使用者[HR 0.41，（95%CI，0.18-0.95），P=0.04]。亚组分析表明，与 ACEI 相比，LVEF 不超过 40%的患者接受 ARNI 治疗的获益更大[HR 0.30，（95%CI，0.11-0.86），P=0.01]或 ARB [HR 0.21，（95%CI，0.04-1.1），P=0.05]。年龄不超过 60 岁的患者复合终点降低[ARNI 与 ARB 的 HR：0.11，（95%CI，0.03-0.46），P=0.002]。
在 AMI 患者中，ARNI 降低长期不良心血管结局的效果优于 ACEI/ARB。亚组分析进一步表明，ARNI 更有可能使 LVEF 小于 40%和年龄小于 60 岁的患者获益。
