Early in-hospital initiation of angiotensin-receptor–neprilysin inhibitor in post-acute myocardial infarction patients with impaired left ventricular systolic function: a systematic review and meta-analysis of randomized controlled trials - Report - MDSpire
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Initiating Angiotensin-Receptor–Neprilysin Inhibitors Early in Hospitalized Patients with Impaired Left Ventricular Systolic Function Post-Acute Myocardial Infarction: A Systematic Review and Meta-Analysis of Randomized Trials
Clinical Report: Initiating ARNI Early in Hospitalized Patients Post-AMI
Overview
This systematic review and meta-analysis evaluated the effects of early in-hospital initiation of angiotensin-receptor–neprilysin inhibitors (ARNIs) in patients with impaired left ventricular systolic function following acute myocardial infarction (AMI).
Background
Heart failure is a significant complication following acute myocardial infarction, particularly in patients with impaired left ventricular systolic function. The initiation of effective therapies during hospitalization is critical for improving outcomes in this high-risk population. Angiotensin-receptor–neprilysin inhibitors have shown promise in chronic heart failure, but their role in the acute setting remains less understood, as highlighted in recent studies.
Data Highlights
Outcome
ARNI
ACEI/ARB
Risk Ratio (95% CI)
Number Needed to Treat
Major Adverse Cardiovascular Events
3,771
3,768
0.58 (0.41–0.83)
≈ 7
Ventricular Arrhythmia
3,771
3,768
0.51 (0.35–0.75)
≈ 25
Improvement in LVEF
+2.54% (1.34 to 3.75)
-
-
-
Reduction in NT-proBNP
-424 pg/mL (−779 to −68)
-
-
-
Adverse Events
Higher rates
-
1.16 (1.14–1.19)
-
Key Findings
Early in-hospital ARNI initiation was associated with a reduction in major adverse cardiovascular events (MACEs) compared to ACEI/ARB therapy.
ARNI therapy was linked to a lower incidence of ventricular arrhythmia.
Patients receiving ARNI showed an improvement in left ventricular ejection fraction (LVEF).
ARNI therapy led to a reduction in NT-proBNP levels.
Higher rates of adverse events were observed with ARNI, particularly symptomatic hypotension.
Clinical Implications
Clinicians should monitor for potential adverse events, particularly hypotension, during treatment with ARNI in hospitalized patients post-AMI with impaired left ventricular systolic function.
Conclusion
Early in-hospital initiation of ARNI therapy in patients with impaired left ventricular systolic function post-AMI requires careful monitoring for adverse events.
