Sacubitril/valsartan compared to ramipril in high-risk post-myocardial infarction patients stratified according to use of mineralocorticoid receptor antagonists: insight from the PARADISE MI trial.

ACE inhibitors Drug adherence Heart failure Left ventricular dysfunction Mineralocorticoid receptor antagonists Myorcardial infarction Sacubitril/valsartan

Journal

European journal of heart failure
ISSN: 1879-0844
Titre abrégé: Eur J Heart Fail
Pays: England
ID NLM: 100887595

Informations de publication

Date de publication:
06 Nov 2023
Historique:
revised: 25 10 2023
received: 02 06 2023
accepted: 31 10 2023
pubmed: 7 11 2023
medline: 7 11 2023
entrez: 7 11 2023
Statut: aheadofprint

Résumé

It is unknown whether safety and clinical endpoints by use of sacubitril/valsartan (an angiotensin receptor-neprilysin inhibitor [ARNI]) are affected by mineralocorticoid receptor antagonists (MRA) in high-risk myocardial infarction (MI) patients. The aim of this study was to examine whether MRA modifies safety and clinical endpoints by use of sacubitril/valsartan in patients with a MI and left ventricular systolic dysfunction (LVSD) and/or pulmonary congestion. Patients (n = 5661) included in the PARADISE MI trial (Prospective ARNI vs. ACE Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events After MI) were stratified according to MRA. Primary outcomes in this substudy were worsening heart failure or cardiovascular death. Safety was defined as symptomatic hypotension, hyperkalaemia >5.5 mmol/L, or permanent drug discontinuation. A total of 2338 patients (41%) were treated with MRA. Safety of ARNI compared to ramipril was not altered significantly by ± MRA, and both groups had similar increase in symptomatic hypotension with ARNI. In patients taking MRA, the risk of hyperkalaemia or permanent drug discontinuation was not significantly altered by ARNI (p > 0.05 for all comparisons). The effect of ARNI compared with ramipril was similar in those who were and were not taking MRA (hazard ratio [HR] Use of a MRA did not modify safety or clinical endpoints related to initiation of ARNI compared to ramipril in the post-MI setting in patients with LVSD and/or congestion.

Identifiants

DOI: 10.1002/ejhf.3079 PMID: 37933184
pubmed: 37933184
doi: 10.1002/ejhf.3079
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2023 European Society of Cardiology.

Références

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Auteurs

Morten Schou (M)

Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark.

Brian Claggett (B)

Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA.

Zi Michael Miao (ZM)

Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA.

Alberto Fernandez (A)

Cardiology Service, Sanatorio Modelo Quilmes, Quilmes, Argentina.

Gerasimos Filippatos (G)

National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece.

Christopher Granger (C)

Duke University Medical Center, Durham, NC, USA.

Karola Jering (K)

Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA.

Aldo P Maggioni (AP)

ANMCO Research Center, Florence, Italy.

Finnian McCausland (F)

Renal Division, Department of Medicine (F.R.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.

Julio Nuñez Villota (JN)

Servicio de Cardiología, Hospital Clínico Universitario, Valencia, Spain.

Jean-Lucien Rouleau (JL)

Montréal Heart Institute, University of Montréal, Montréal, QC, Canada.

Freny Vaghaiwalla Mody (FV)

Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Division of Cardiology, University of California, Los Angeles, CA, USA.
David Geffen School of Medicine, University of California, Los Angeles, CA, USA.

Peter van der Meer (P)

Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Dragos Vinereanu (D)

University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania.

Martina McGrath (M)

Renal Division, Department of Medicine (F.R.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.

Yinong Zhou (Y)

Novartis Pharmaceutical Corporation, East Hanover, NJ, USA.

Douglas L Mann (DL)

Washington University School of Medicine, St Louis, MO, USA.

Scott D Solomon (SD)

Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA.

Philippe Gabriel Steg (PG)

Université de Paris, AP-HP (Assistance Publique-Hôpitaux de Paris), FACT (French Alliance for Cardiovascular Trials) and INSERM U-1148, Paris, France.

Eugene Braunwald (E)

TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA.

John J V McMurray (JJV)

British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland.

Marc A Pfeffer (MA)

Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA.

Lars Køber (L)

Rigshospitalet, Blegdamsvej, University of Copenhagen, Copenhagen, Denmark.

Classifications MeSH