Meta-analysis Of The Effect Of Sacubitril Valsartan On Acute Myocardial Infarction With Associated Heart Failure

Objective:To understand the impact of sacubitril valsartan compared to ACEI/ARB in the treatment of acute myocardial infarction with associated heart failure,to assess whether it is effective in improving cardiac function and reducing the incidence of cardiovascular events and adverse events after myocardial infarction,and to provide an evidence-based basis for clinical use of the drug.Methods:Randomised controlled trials of sacubitril valsartan in patients with acute myocardial infarction with heart failure were searched using Embase,Pubmed,Cochrane Library,China Knowledge Network and Wanfang databases,with the search period limited to 1 January 2023,and studies were rigorously screened according to nadir criteria,quality assessed and data extracted.Review Manager 5.4 was used for analysis.Results:Twenty-one publications with a total of 7571 patients were included.The results of this study showed that,compared to controls,the sacubitril valsartan group improved left ventricular ejection fraction [MD=4.13,95%CI(2.42,5.83),P<0.05];reduced left ventricular end-diastolic internal diameter in patients [MD=-3.31,95%CI(-4.51,-2.11),P<0.05];reduced N-terminal B-type natriuretic peptide levels [SMD=-3.58,95%CI(-4.46,-2.69),P<0.05];improved 6-minute walk test results [MD=59.58,95%CI(51.41,67.75),P<0.05];reduced cardiovascular event rates[RR=0.49,95% CI(0.34,0.70),P<0.05];and in terms of the incidence of adverse reactions,the incidence of hypotension was higher in the sacubitril valsartan group [RR=1.29,95% CI(1.18,1.41),P<0.05],the incidence of hyperkalemia was higher but not statistically significant [RR=1.05,95% CI(0.90,1.22),P=0.54],and the incidence of dry cough was lower [RR=0.69,95% CI(0.60,0.80),P<0.05],and a lower but not statistically significant incidence of angioedema [RR=0.74,95% CI(0.40,1.38),P=0.34].Conclusions:Sacubitril valsartan compared with ACEI/ARB improved left ventricular remodelling,increased left ventricular function,improved patients’ activity tolerance and reduced cardiovascular events.There were no significant differences in adverse effects.