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

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.

Related Resources & Content

1. DiPietro et al., Frontiers in Cardiovascular Medicine, 2026 -- The in-hospital administration of sacubitril/valsartan in acute myocardial infarction: A meta-analysis

2. Böhm et al., European Journal of Preventive Cardiology, 2023 -- Angiotensin receptor-neprilysin inhibition in acute myocardial infarction: A systematic review

3. Klein et al., Critical Care, 2025 -- Early initiation of ARNI therapy in patients with acute myocardial infarction: A meta-analysis

4. Packer et al., European Heart Journal, 2021 -- The role of ARNI in acute heart failure following myocardial infarction

5. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes, JACC, 2024 -- Title

6. Angiotensin Receptor-Neprilysin Inhibition in Acute Myocardial Infarction - PubMed, 2021 -- Title

7. The in‐hospital administration of sacubitril/valsartan in acute myocardial infarction: A meta‐analysis, 2024 -- Title

8. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines | JACC

9. Angiotensin Receptor-Neprilysin Inhibition in Acute Myocardial Infarction - PubMed

10. The in‐hospital administration of sacubitril/valsartan in acute myocardial infarction: A meta‐analysis