Hu Wei-Syun, Lin Cheng-Li
School of Medicine, College of Medicine, China Medical University, Taichung, 40402, Taiwan.
Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan.
Naunyn Schmiedebergs Arch Pharmacol. 2025 May 5. doi: 10.1007/s00210-025-04223-7.
The research aims at identifying the risk of adverse events, including acute myocardial infarction (AMI) readmission, heart failure (HF) readmission, and cardiovascular (CV) death induced by sacubitril/valsartan in patients with end-stage renal disease (ESRD) and HF. This data came from the Taiwan National Health Insurance Research Database (NHIRD). Propensity scoring (PS) matching was used. Cox proportional hazard model was applied to calculate the hazard ratio (HR) and 95% confidence interval (CI) for adverse events among the study groups. After propensity score matching, among HF + ESRD patients, 854 received sacubitril/valsartan, and the other 854 patients did not. Compared to patients who did not receive sacubitril/valsartan, patients with sacubitril/valsartan were more likely to suffer AMI readmission (aHR = 1.85, 95% CI = 1.42-2.41), HF readmission (aHR = 2.21, 95% CI = 1.93-2.55), and CV death (aHR = 1.65, 95% CI = 1.28-2.12) after matching. Patients who received sacubitril/valsartan for less than 75 days had a greater risk of AMI readmission (aHR = 2.83, 95% CI = 2.27-3.53), HF readmission (aHR = 5.36, 95% CI = 4.75-6.06), and CV death (aHR = 2.27, 95% CI = 1.81-2.85) than non-sacubitril/valsartan cohorts. However, when the patients received sacubitril/valsartan for ≥ 185 days, they had a trend toward a lower risk of AMI readmission (aHR = 0.66, 95% CI = 0.41-1.04), HF readmission (aHR = 0.84, 95% CI = 0.68-1.03), and CV death (aHR = 0.83, 95% CI = 0.55-1.24) than the non-sacubitril/valsartan cohort, although it did not reach statistical significance. This study highlights significant risks associated with sacubitril/valsartan, particularly in the short term, and the protective effect of prolonged use of sacubitril/valsartan in HF + ESRD patients.
该研究旨在确定沙库巴曲缬沙坦在终末期肾病（ESRD）合并心力衰竭（HF）患者中诱发不良事件的风险，这些不良事件包括急性心肌梗死（AMI）再入院、HF再入院以及心血管（CV）死亡。该数据来自台湾国民健康保险研究数据库（NHIRD）。采用倾向评分（PS）匹配法。应用Cox比例风险模型计算研究组中不良事件的风险比（HR）和95%置信区间（CI）。倾向评分匹配后，在HF+ESRD患者中，854例接受了沙库巴曲缬沙坦治疗，另外854例患者未接受该治疗。与未接受沙库巴曲缬沙坦治疗的患者相比，接受沙库巴曲缬沙坦治疗的患者在匹配后更有可能发生AMI再入院（校正HR = 1.85，95% CI = 1.42 - 2.41）、HF再入院（校正HR = 2.21，95% CI = 1.93 - 2.55）和CV死亡（校正HR = 1.65，95% CI = 1.28 - 2.12）。接受沙库巴曲缬沙坦治疗少于75天的患者发生AMI再入院（校正HR = 2.83，95% CI = 2.27 - 3.53）、HF再入院（校正HR = 5.36，95% CI = 4.75 - 6.06）和CV死亡（校正HR = 2.27，95% CI = 1.81 - 2.85）的风险高于未接受沙库巴曲缬沙坦治疗的队列。然而，当患者接受沙库巴曲缬沙坦治疗≥185天时，与未接受沙库巴曲缬沙坦治疗的队列相比，他们发生AMI再入院（校正HR = 0.66，95% CI = 0.41 - 1.04）、HF再入院（校正HR = 0.84，95% CI = 0.68 - 1.03）和CV死亡（校正HR = 0.83，95% CI = 0.55 - 1.24）的风险有降低趋势，尽管未达到统计学意义。本研究强调了沙库巴曲缬沙坦相关的重大风险，尤其是在短期内，以及长期使用沙库巴曲缬沙坦对HF+ESRD患者的保护作用。
