Effect Of Sacubitril/valsartan On Early Ventricular Remodeling In Elderly Patients With Acute Myocardial Infarction

Background:Ventricular remodeling after acute myocardial infarction(AMI)is an independent predictor of heart failure(HF).At present,sacubitril-valsartan sodium has been included in the guidelines for the treatment of HF and has been widely used in clinical practice.Elderly people are at high risk of acute myocardial infarction,and it is unclear about the effect of sacubitril valsartan sodium(Sacubitril/Valsartan)on early ventricular remodeling after AMI in the elderly.Objective:To evaluate the effect of sacubitril-valsartan sodium on early ventricular remodeling in elderly patients with acute myocardial infarction(AMI)compared with traditional renin angiotensin system inhibitors(RASI).Methods:A single-center,prospective,randomized controlled clinical trial was conducted in 68 elderly patients who visited Dalian Friendship Hospital from November 2021 to November 2022 and were diagnosed with acute myocardial infarction and successfully treated with percutaneous coronary intervention(PCI).They were randomly divided into control group(n=3 4)and experimental group(n=34).Basic data were collected after admission:gender,age,body mass index(BMI),risk factors of coronary heart disease,Killip class,type of myocardial infarction,and combined medication(such as antiplatelet drugs,lipid-regulating drugs,β-blockers,aldosterone receptor antagonists,diuretics,etc.).All patients received conventional treatment after PCI,the control group was given enalapril maleate/valsartan capsules,and the experimental group was given sacubitril valsartan sodium.All patients were initiated and gradually titrated to the target dose of the drug for maintenance according to basal blood pressure and their own tolerance.After a follow-up period of 1 month,echocardiographic parameters before and after treatment were recorded:left ventricular ejection fraction(LVEF),left ventricular end systolic volume(LVESV),left ventricular end diastolic volume(LVEDV),left ventricular mass index(LVMI)and laboratory blood biochemical parameters:N-terminal pro-B-type natriuretic peptide(NT-proBNP),serum creatinine(Scr),cystatin C(Cys-C),C-reactive protein(CRP).The incidence of common adverse drug reactions(symptomatic hypotension,angioedema,renal function deterioration,hyperkalemia,etc.)and major adverse cardiovascular events(MACE)(such as acute attack of heart failure,cardiac death,severe arrhythmia,etc.)during follow-up was recorded.Results:A total of 6 8 patients who met the inclusion criteria were treated in Dalian Friendship Hospital from November 2021 to November 2022,of which 18 patients were excluded due to no follow-up results of echocardiography,and finally 26 patients were included in the study case control group and 24 patients in the experimental group.All included patients completed the follow-up.There was no significant difference between the two groups in general data(age,gender,BMI),risk factors of coronary heart disease(hypertension,hyperlipidemia,diabetes,smoking),myocardial infarction classification,cardiac functional classification(Killip class)and concomitant medication(P>0.0 5),and the overall matching was good and comparable.1.The serum NT-proBNP levels in the experimental group and the control group were significantly lower than those before treatment(P<0.01),and the levels in the experimental group were significantly lower than those in the control group(P<0.05).2.One month after treatment,Scr and Cys-C in the experimental group and the control group were lower than those before treatment(P<0.01).Compared with the control group,there was no significant difference in Scr level between the experimental group and the control group(P>0.05).The Cys-C level in the experimental group was lower than that in the control group(P<0.01).3.One month after treatment,the serum CRP level in the experimental group and the control group was significantly lower than that before treatment(P<0.01),and the serum CRP level in the experimental group was lower than that in the control group 1 month after treatment(P<0.01).4.Before treatment,the left ventricular size and function of the test group were similar to those of the control group.There was no significant difference in LVEF,LVESV,LVEDV and LVMI levels before treatment between the two groups(P>0.05);LVEF,LVESV,LVEDV and LVMI 1 month after treatment were improved compared with those before treatment(P<0.01).And 1 month after treatment,LVEF increased more significantly(P<0.05),LVESV,LVEDV,LVMI decreased more significantly(P<0.01;P<0.01;P<0.05)in the experimental group than in the control group.5.During the 1-month treatment follow-up period,no common adverse drug reactions(such as symptomatic hypotension,angioedema,deterioration of renal function and hyperkalemia)occurred in the experimental group and the control group,and no major cardiovascular adverse events(such as acute attack of heart failure,cardiac death and malignant arrhythmia)occurred during the follow-up period in the two groups.Conclusion:1.Early application of sacubitril-valsartan sodium after PCI in elderly patients with acute myocardial infarction can improve cardiac function,inhibit and reverse ventricular remodeling,and the effect is better than ACEI/ARB drugs.2.Sacubitril valsartan sodium can inhibit the inflammatory response after myocardial infarction and delay and improve ventricular remodeling.3.Sacubitril valsartan sodium can improve acute kidney injury after PCI in elderly patients with AMI and has a certain protective effect on renal function.4.Adverse reactions and cardiovascular adverse events did not occur during follow-up in both groups,suggesting that sacubitril-valsartan sodium has some safety in the application of elderly AMI patients.