BACKGROUND

ST-segment elevation myocardial infarction (STEMI) is responsible for high morbidity and mortality rates globally. Although the use of angiotensin-converting enzyme inhibitors (ACEIs) remains the cornerstone treatment for patients with STEMI, the use of angiotensin-receptor neprilysin inhibitors (ARNIs) may offer better outcomes than ACEIs. This meta-analysis compares the efficacy and safety of ARNIs versus ACEIs in patients with STEMI.

METHODS

Randomized controlled trials (RCTs) were pooled from PubMed and Cochrane databases. A random-effects model calculated risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs).

RESULTS

Five trials ( = 4,915) were included. ARNIs significantly reduced major adverse cardiovascular events (MACE) (RR: 0.66, 95% CI [0.50, 0.86];  = 0.002) and hospitalizations for heart failure (HHF) (RR: 0.67, 95% CI [0.49, 0.92];  = 0.01). ARNIs also improved left ventricular ejection fraction (LVEF) (WMD: 2.60, 95% CI[1.53, 3.68];  < 0.00001) and lowered NT-proBNP levels (WMD: -268.89, 95% CI[-422.35, -115.42]; = 0.0006). No significant differences were observed in recurrent myocardial infarction, cardiovascular death, or safety outcomes - except for hypotension, which was significantly more common with ARNI use.

CONCLUSIONS

ARNI therapy reduces MACE, HHF, and NT-proBNP levels and improves LVEF in patients with STEMI without increasing safety risks, except for hypotension. Further RCTs are needed to confirm these findings.