Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China.
Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China.
Eur J Intern Med. 2023 Jun;112:62-69. doi: 10.1016/j.ejim.2023.03.019. Epub 2023 Mar 27.
In real-world clinical practice, the initiation and up-titration of sacubitril/valsartan remain challenging due to symptomatic hypotension in patients with acute myocardial infarction(AMI). The purpose of this study was to investigate the efficacy of different initial timing and dosage of sacubitril/valsartan in AMI patients.
This prospective and observational cohort study enrolled AMI patients treated with percutaneous coronary intervention(PCI), and were categorized according to the initial timing and average daily doses of sacubitril/valsartan prescription. The primary endpoint was defined as a composite of cardiovascular death, recurrent AMI, coronary revascularization, heart failure(HF) hospitalization and ischaemic stroke. Secondary outcomes included the new-onset HF, and the composite endpoints in AMI patients complicated with HF at baseline.
The study population consisted of 915 AMI patients. After a median follow-up of 38 months, early use or high dosage of sacubitril/valsartan was associated with an improvement in primary endpoint as well as the incidence of new-onset HF. Early use of sacubitril/valsartan also ameliorated the primary endpoint in AMI patients with left ventricular ejection fraction(LVEF) ≤50% as well as LVEF>50%. Besides, early use of sacubitril/valsartan improved the clinical outcomes in AMI patients complicated with HF at baseline. The low dose was well tolerated and may be associated with similar outcomes compared with high dose under some circumstances(LVEF>50% or HF at baseline).
Early use or high dosage of sacubitril/valsartan medication is associated with an improvement in clinical outcome. The low dose of sacubitril/valsartan is well tolerated and may be an acceptable alternative strategy.
在真实临床实践中，由于急性心肌梗死（AMI）患者出现症状性低血压，起始和滴定沙库巴曲缬沙坦仍然具有挑战性。本研究旨在探讨 AMI 患者中不同起始时间和剂量沙库巴曲缬沙坦的疗效。
这是一项前瞻性观察性队列研究，纳入接受经皮冠状动脉介入治疗（PCI）的 AMI 患者，并根据沙库巴曲缬沙坦处方的起始时间和平均日剂量进行分类。主要终点定义为心血管死亡、再发 AMI、冠状动脉血运重建、心力衰竭（HF）住院和缺血性卒中的复合终点。次要结局包括新发 HF 和基线合并 HF 的 AMI 患者的复合终点。
该研究人群包括 915 名 AMI 患者。中位随访 38 个月后，早期使用或高剂量沙库巴曲缬沙坦可改善主要终点以及新发 HF 的发生率。早期使用沙库巴曲缬沙坦也改善了左心室射血分数（LVEF）≤50%和 LVEF>50%的 AMI 患者的主要终点。此外，早期使用沙库巴曲缬沙坦改善了基线合并 HF 的 AMI 患者的临床结局。低剂量沙库巴曲缬沙坦耐受性良好，在某些情况下（LVEF>50%或基线时 HF）可能与高剂量具有相似的结局。
早期使用或高剂量沙库巴曲缬沙坦药物与临床结局改善相关。低剂量沙库巴曲缬沙坦耐受性良好，可能是一种可接受的替代策略。
