Clinical Report: Variable Outcomes of Early Initiation of Sacubitril/Valsartan Following PCI

Overview

This study evaluates the timing of sacubitril/valsartan initiation in elderly patients post-PCI.

Background

The timing of sacubitril/valsartan initiation after PCI in elderly patients with left ventricular dysfunction is not well defined.

Data Highlights

Key Findings

• Early initiation of sacubitril/valsartan was associated with improvement in left ventricular ejection fraction and cardiac index at 8 weeks.
• Patients in the early initiation group experienced reductions in left ventricular dimensions.
• Biomarkers such as hs-CRP and NT-proBNP showed declines in the early initiation group.
• Major adverse cardiovascular events occurred in 8.3% of the early group compared to 20.8% in the delayed group and 25.0% in the control group.
• Exploratory analyses indicated benefits in patients aged ≥75 years and those with baseline LVEF ≤40%.
• Safety outcomes were comparable across all treatment groups.

Clinical Implications

The findings suggest that initiating sacubitril/valsartan within 7 days post-PCI may enhance myocardial recovery and reduce cardiovascular risk in elderly patients. Clinicians should consider the timing of ARNI therapy in this vulnerable population to optimize outcomes.

Conclusion

Early initiation of sacubitril/valsartan after PCI appears to confer significant benefits in myocardial recovery and cardiovascular outcomes in elderly patients with left ventricular dysfunction. Further prospective studies are warranted to confirm these findings.

Related Resources & Content

1. Frontiers in Cardiovascular Medicine, 2026 -- Safety and efficacy of sacubitril/valsartan vs. benazepril administered as initial treatment for STEMI patients with mid-range ejection fraction: a propensity score matching analysis
2. Clinical Research in Cardiology, 2023 -- Impact of sacubitril/valsartan on cardiac structural changes in comparison to other renin-angiotensin system blockers: a difference-in-difference analysis using propensity-score matched cohorts
3. Pediatric Cardiology, 2025 -- Experience at a Single Institution Using Sacubitril/Valsartan for Heart Failure in Individuals with Congenital Heart Disease
4. Clinical Research in Cardiology, 2025 -- Outcomes in Heart Failure Patients Based on Average Daily Sacubitril/Valsartan Dosage: A Nationwide Longitudinal Study
5. ACC Expert Consensus for Treatment of HFrEF: Key Points - American College of Cardiology, 2024
6. Prospective ARNI versus ACE Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events After MI - American College of Cardiology
7. Effect of sacubitril–valsartan on left ventricular remodeling in patients with acute myocardial infarction after primary percutaneous coronary intervention: a systematic review and meta-analysis
8. A clinical randomized trial: Effects of early application of sacubitril/valsartan on ventricular remodeling and prognosis in acute myocardial infarction patients
9. The real-world safety of sacubitril / valsartan among older adults (≥75): A pharmacovigilance study from the FDA data
10. ACC Expert Consensus for Treatment of HFrEF: Key Points - American College of Cardiology
11. Prospective ARNI versus ACE Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events After MI - American College of Cardiology