Ahmed Aymen, Sohail Muhammad Umer, Saad Muhammad, Naveed Zara, Arshad Muhammad Sameer, Jawed Areesha, Musheer Adeena, Paracha Anousheh Awais, Siddiqi Ahmed Kamal, Paryani Neha Saleem, Shahid Izza, Memon Muhammad Mustafa
Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.
Future Cardiol. 2025 Jun;21(8):599-609. doi: 10.1080/14796678.2025.2506350. Epub 2025 May 26.
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.
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).
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.
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.
ST段抬高型心肌梗死（STEMI）在全球范围内导致高发病率和死亡率。尽管使用血管紧张素转换酶抑制剂（ACEI）仍然是STEMI患者的基石治疗方法，但使用血管紧张素受体脑啡肽酶抑制剂（ARNI）可能比ACEI带来更好的治疗效果。本荟萃分析比较了ARNI与ACEI在STEMI患者中的疗效和安全性。
从PubMed和Cochrane数据库中汇总随机对照试验（RCT）。采用随机效应模型计算风险比（RR）和加权平均差（WMD），并给出95%置信区间（CI）。
纳入了五项试验（n = 4915）。ARNI显著降低了主要不良心血管事件（MACE）（RR：0.66，95%CI[0.50，0.86]；P = 0.002）和因心力衰竭住院（HHF）（RR：0.67，95%CI[0.49，0.92]；P = 0.01）。ARNI还改善了左心室射血分数（LVEF）（WMD：2.60，95%CI[1.53，3.68]；P < 0.00001）并降低了NT-proBNP水平（WMD：-268.89，95%CI[-422.35，-115.42]；P = 0.0006）。在再发心肌梗死、心血管死亡或安全性结局方面未观察到显著差异——除了低血压，ARNI使用时低血压明显更常见。
ARNI治疗可降低STEMI患者的MACE、HHF和NT-proBNP水平，并改善LVEF，除低血压外不会增加安全风险。需要进一步的随机对照试验来证实这些发现。
