Abstract
The PARADISE-MI study compared standard treatment with an ACE inhibitor (ramipril) after an acute myocardial infarction with the newer sacubitril/ valsartan combination (so-called ARNI) medication in 5661 patients. Most patients had a reduced cardiac function (40% ejection fraction or less) and in about 50% of patients it was accompanied by complaints of congestion. The expected 15% reduction in primary endpoint cardiovascular death or rehospitalization or extra visits for heart failure was not met after 22 months. The study is characterized by an increased incidence of symptomatic hypotension of 28,3% in the group treated with the ARNI, compared to an incidence of 21,9% in the group treated with the ACE inhibitor. The interpretation of the trial is hampered by the mixed design of prevention and treatment trial for heart failure. A continuing careful approach is advised with ACE inhibitors as first choice in the first week(s) after myocardial infarction.
| Translated title of the contribution | Angiotensine Receptor-Neprilysin Inhibitor combination is not the preferred medication for patients after acute myocardial infarction |
|---|---|
| Original language | Dutch |
| Journal | Nederlands Tijdschrift voor Geneeskunde |
| Volume | 166 |
| Publication status | Published - 31 May 2022 |
Keywords
- Aminobutyrates
- Angiotensin Receptor Antagonists/therapeutic use
- Angiotensin-Converting Enzyme Inhibitors/therapeutic use
- Antihypertensive Agents/therapeutic use
- Biphenyl Compounds
- Drug Combinations
- Heart Failure/drug therapy
- Humans
- Myocardial Infarction/drug therapy
- Neprilysin/pharmacology
- Receptors, Angiotensin/therapeutic use
- Stroke Volume
- Tetrazoles/pharmacology
- Treatment Outcome