Ramipril on par with sacubitril/valsartan combo in acute myocardial infarction

Combination treatment with sacubitril and valsartan appears to be no better than ramipril in reducing the risk of cardiovascular death and heart failure (HF) in patients with acute myocardial infarction (AMI) complicated by left ventricular dysfunction, regardless of AMI type, reveals a study.

In the PARADISE-MI* trial, investigators enrolled 5,661 patients with AMI complicated by left ventricular dysfunction and/or pulmonary congestion and at least one risk-enhancing factor. They randomized participants to receive either sacubitril/valsartan or ramipril.

Death from cardiovascular causes or incident HF was the primary endpoint. In prespecified analysis, patients were stratified based on AMI type.

About three in four patients (n=4,291, 75.8 percent) had ST-segment elevation myocardial infarction (STEMI). These patients tended to be younger and have fewer comorbidities and cardiovascular risk factors than those with non‒ST-segment elevation myocardial infarction (NSTEMI).

NSTEMI patients showed a marginally higher risk for the primary outcome than STEMI patients after adjusting for potential confounders (adjusted hazard ratio [HR], 1.19, 95 percent CI, 1.00‒1.41), with borderline statistical significance (p=0.05).

Notably, the primary composite outcome occurred at similar rates between the sacubitril/valsartan and ramipril arms in STEMI (10 percent vs 12 percent; HR, 0.87, 95 percent CI, 0.73‒1.04; p=0.13) and NSTEMI patients (17 percent vs 17 percent; HR, 0.97, 95 percent CI, 0.75‒1.25; p=0.80; p=0.53 for interaction).

*Prospective ARNI versus ACE inhibitor trial to DetermIne Superiority in reducing heart failure Events after Myocardial Infarction