Suppr超能文献

血管紧张素受体脑啡肽酶抑制剂与血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂在心肌梗死后的疗效比较:一项荟萃分析

The Efficacy of Angiotensin Receptor-Neprilysin Inhibitor Versus Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Post Myocardial Infarction: A Meta-Analysis.

作者信息

Kotak Sohny, Hassan Warda, Mehmood Marium, Kumar Umesh, Sagreeka Fnu, Karishma Fnu, Kumari Pirya, Pirya Fnu, Saquib Javeria, Iqbal Amna, Khan Anosh Aslam, Varrassi Giustino, Khatri Mahima, Kumar Satesh

机构信息

Internal Medicine, Dow University of Health Sciences, Karachi, PAK.

Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK.

出版信息

Cureus. 2023 Oct 5;15(10):e46547. doi: 10.7759/cureus.46547. eCollection 2023 Oct.

Abstract

Acute myocardial infarction (MI) is one of the leading global healthcare emergencies, contributing to over three million global deaths. The purpose of this study is to investigate further the efficacy of sacubitril/valsartan over angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in reducing the risk of heart failure (HF) in post-MI patients and providing a clear evidence-based medicine guideline for future use. An electronic database search was conducted on English databases. Eight articles were included, fulfilling our inclusion criteria, i.e., adult patients of ≥18 years with a recent diagnosis of acute MI. Pooled analysis was done using Review Manager version 5.4.1 (Cochrane Collaboration, London, England), and the data for each outcome were analyzed as dichotomous variables. A total of eight clinical trials were included in the meta-analysis. Six studies analyzed the sacubitril/valsartan and ACEI combination. The pooled analysis reported a significant increase in the risk of hypotension (relative risk {RR}: 1.29 {1.18, 1.41}) in the sacubitril/valsartan compared to the ACEI alone group. In addition, a significant increase was observed in the left ventricle ejection fraction (LVEF) after using the sacubitril/valsartan combination compared to using ACEI alone (RR: 3.08 {2.68, 4.48}). Furthermore, no significant difference was observed between the groups in terms of mortality rate (RR: 0.86 {0.73, 1.02}), the risk of heart failure (RR: 0.62 {0.39, 1.00}), the frequency of recurrent MI (RR: 0.86 {0.27, 2.76}), and the mean difference of N-terminal pro-B-type natriuretic peptide (NT-proBNP) (weighted mean difference {WMD}: -174.36 {-414.18, 65.46}) between both the groups. However, the sacubitril/valsartan combination proved to be beneficial in significantly reducing the risk of major adverse cardiac events (MACE) (RR: 0.64 {0.48, 0.84}) and rehospitalizations (RR: 0.53 {0.39, 0.71}) as compared to ACEI post MI. Additionally, sacubitril/valsartan and ARB's combination was reported in two studies. This led to a significant decrease in NT-proBNP concentration (WMD: -71.91 {-138.43, -5.39}) post MI in the sacubitril/valsartan combination group compared to the ARB usage alone. However, no significant difference was observed in the improvement of LVEF (WMD: 0.88 {-5.11, 6.87}) between both groups. Although the sacubitril/valsartan combination has no difference in mortality and outcomes compared to ACEI, there is evidence that using it proves to be more beneficial post MI compared to ACEI and ARB usage alone.

摘要

急性心肌梗死(MI)是全球主要的医疗紧急情况之一,导致全球超过300万人死亡。本研究的目的是进一步探讨沙库巴曲缬沙坦相对于血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体阻滞剂(ARB)在降低心肌梗死后患者心力衰竭(HF)风险方面的疗效,并为未来使用提供明确的循证医学指南。我们对英文数据库进行了电子检索。共纳入8篇符合我们纳入标准的文章,即年龄≥18岁、近期诊断为急性心肌梗死的成年患者。使用Review Manager 5.4.1版(英国伦敦科克伦协作网)进行汇总分析,并将每个结局的数据作为二分变量进行分析。荟萃分析共纳入8项临床试验。6项研究分析了沙库巴曲缬沙坦与ACEI的联合使用。汇总分析报告,与单用ACEI组相比,沙库巴曲缬沙坦组低血压风险显著增加(相对风险{RR}:1.29{1.18,1.41})。此外,与单用ACEI相比,使用沙库巴曲缬沙坦联合治疗后左心室射血分数(LVEF)显著增加(RR:3.08{2.68,4.48})。此外,两组在死亡率(RR:0.86{0.73,1.02})、心力衰竭风险(RR:0.62{0.39,1.00})、心肌梗死复发频率(RR:0.86{0.27,2.76})以及两组之间N末端B型利钠肽原(NT-proBNP)的平均差异(加权平均差异{WMD}:-174.36{-414.18,65.46})方面未观察到显著差异。然而,与心肌梗死后使用ACEI相比,沙库巴曲缬沙坦联合治疗被证明在显著降低主要不良心脏事件(MACE)风险(RR:0.64{0.48,0.84})和再住院率(RR:0.53{0.39,0.71})方面有益。此外,两项研究报告了沙库巴曲缬沙坦与ARB的联合使用。与单用ARB相比,沙库巴曲缬沙坦联合治疗组心肌梗死后NT-proBNP浓度显著降低(WMD:-71.91{-138.43,-5.39})。然而,两组之间在LVEF改善方面未观察到显著差异(WMD:0.88{-5.11,6.87})。尽管沙库巴曲缬沙坦联合治疗与ACEI相比在死亡率和结局方面无差异,但有证据表明,与单用ACEI和ARB相比,心肌梗死后使用沙库巴曲缬沙坦联合治疗更有益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e136/10625497/6f84a2f73219/cureus-0015-00000046547-i01.jpg

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验