The Benefits of Sacubitril/Valsartan Administration in Patients with ST-Segment Elevation Myocardial Infarction: A Meta-Analysis

Abstract

AbstractPurpose This meta-analysis aimed to clarify the clinical effects and safety of Sacubitril/Valsartan (Sac/Val) administration in patients with ST-segment elevation myocardial infarction (STEMI). Methods This analysis was registered with PROSPERO (CRD42022364008). Researchers performed a systematic search of English and Chinese databases to identify available randomized controlled trials from inception to September 30, 2022. The experimental group was given Sac/Val, while the control group was given conventional angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). Study screening and data extraction were conducted by two independent researchers. Cochrane Handbook 6.3 was used for quality evaluation and bias assessment. Risk ratio (RR) and 95% confidential interval (95% CI) were adopted for enumeration data. Mean difference (MD) and 95% CI were adopted for measurement data. Results A total of 7 studies with 964 patients were included in the meta-analysis. The outcomes of clinical effects, including rehospitalization for heart failure (HF), left ventricular ejection fraction (LVEF), major adverse cardiac events (MACEs), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration at 24 weeks, were respectively RR = 0.45 (95% CI: 0.35 to 0.66), MD = 3.44 (95% CI: 2.66 to 4.22), RR = 0.50 (95% CI: 0.40 to 0.62), and MD=-155.55 (95% CI: -226.35 to -84.75). Meanwhile, the outcomes of adverse side effects, including hypotension, hyperkalemia, cough, and worsening renal function, were respectively RR = 1.81 (95% CI: 1.09 to 3.02), RR = 0.58 (95% CI: 0.17 to 1.93), RR = 0.84 (95% CI: 0.26 to 2.72), and RR = 0.55 (95% CI: 0.23 to 1.33). Conclusions Compared with conventional ACEI/ARB, Sac/Val was found to improve cardiac function, decrease the risk of HF, and reduce MACEs incidence in patients after STEMI. However, in terms of adverse side effects, Sac/Val did not show a significant advantage over ACEI/ARB.