依那普利
沙库比林、缬沙坦
医学
缬沙坦
内科学
心脏病学
沙库比林
心肌梗塞
临床终点
心力衰竭
冠状动脉疾病
射血分数
血管紧张素转换酶
血压
随机对照试验
作者
Ulrik M. Mogensen,Lars Køber,Søren Lund Kristensen,Pardeep S. Jhund,Jianjian Gong,Martin Lefkowitz,Adel R. Rizkala,Jean L. Rouleau,Victor Shi,Karl Swedberg,Michael R. Zile,Scott D. Solomon,Milton Packer,John J.V. McMurray
标识
DOI:10.1016/j.ahj.2017.02.034
摘要
Angiotensin converting enzyme inhibitors (ACE-I), are beneficial both in heart failure with reduced ejection fraction (HF-REF) and after myocardial infarction (MI). We examined the effects of the angiotensin-receptor neprilysin inhibitor sacubitril/valsartan, compared with the ACE-I enalapril, on coronary outcomes in PARADIGM-HF. We examined the effect of sacubitril/valsartan compared with enalapril on the following outcomes: i) the primary composite endpoint of cardiovascular (CV) death or HF hospitalization, ii) a pre-defined broader composite including, in addition, MI, stroke, and resuscitated sudden death, and iii) a post hoc coronary composite of CV-death, non-fatal MI, angina hospitalization or coronary revascularization. At baseline, of 8399 patients, 3634 (43.3%) had a prior MI and 4796 (57.1%) had a history of any coronary artery disease. Among all patients, compared with enalapril, sacubitril/valsartan reduced the risk of the primary outcome (HR 0.80 [0.73–0.87], P < .001), the broader composite (HR 0.83 [0.76–0.90], P < .001) and the coronary composite (HR 0.83 [0.75–0.92], P < .001). Although each of the components of the coronary composite occurred less frequently in the sacubitril/valsartan group, compared with the enalapril group, only CV death was reduced significantly. Compared with enalapril, sacubitril/valsartan reduced the risk of both the primary endpoint and a coronary composite outcome in PARADIGM-HF. Additional studies on the effect of sacubitril/valsartan on atherothrombotic outcomes in high-risk patients are merited.
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