Early sacubitril/valsartan initiation after cardiac bypass surgery safe, effective

For patients who have undergone coronary artery bypass graft (CABG), initiating treatment with sacubitril/valsartan early is safe and appears to improve outcomes, as shown in an open-label study.

A total of 77 patients (mean age 63 years, 75.3 percent men) were randomly assigned to receive sacubitril/valsartan either immediately following haemodynamic stabilization (early, n=39) or from 2 to 4 weeks (late, n=38) after CABG. The starting dose of sacubitril/valsartan was 24/26 mg or 49/51 mg, administered two times per day.

All patients were followed up every 4 weeks to assess safety (primary endpoint) and the secondary endpoints such as the quality of life, the N-terminal pro-B-type natriuretic peptide (NT-proBNP), and 6 min walk test (6MWT).

Of the patients, 84.4 percent were in the NYHA class III at baseline. More than half (58.4 percent) were naïve to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, and 49.4 percent were receiving diuretics. The mean systolic blood pressure (SBP) was 118 mm Hg, with the SBP below 110 mm Hg for 31.1 percent of the patients. Sacubitril/valsartan was initially given at 24/26 mg in 46.7 percent of patients and at 49/51 mg in the remaining patients. The median NT-proBNP concentration was 1,074.

Treatment discontinuation rates were low in both the early and late groups (2.5 percent and 5.2 percent, respectively). Furthermore, renal function, hyperkalaemia, and symptomatic hypotension occurred rarely and did not significantly differ between the two treatment groups.

In terms of efficacy, both early and late groups achieved significant improvements in quality of life and distance at the 6MWT (p<0.001). However, the early group showed a significantly greater decrease in the NT-proBNP concentration compared with the late group (p<0.001).