Ahmed Rezq1,2, Marwan Saad1,3, Mostafa El Nozahi1. 1. Department of Cardiology, Ain Shams University Cairo, Egypt. 2. Department of Cardiology, Dar Al Fouad Hospital Cairo, Egypt. 3. Cardiovascular Institute, Warren Alpert Medical School at Brown University Providence, RI, USA.
Abstract
OBJECTIVES: To evaluate the safety and efficacy of sacubitril/valsartan versus ramipril in patients with STEMI and cardiogenic shock. METHODS: Patients who received primary percutaneous coronary intervention (PPCI) for STEMI complicated with cardiogenic shock were randomized 1:1 to sacubitril/valsartan versus ramipril after clinical stabilization. The primary outcome was major adverse cardiac events (MACE) at 30 days and 6 months. Secondary in-hospital clinical outcomes included recurrent shock, new or re-initiation of vasoactive medications, and acute kidney injury (AKI). All-cause death, cardiac death, hospitalization due to heart failure (HF), myocardial infarction (MI), and stroke were examined at 30 days and 6 months. Study ID 016-01-2018. RESULTS: 100 patients with STEMI and cardiogenic shock were included (mean age 54.7±10.3 years, 87% men). Initiation of sacubitril/valsartan and ramipril occurred at 38.18±18.44 versus 39.0±21.03 hours after stabilization, respectively. The primary outcome was similar between both groups at 30 days and 6 months. No difference in in-hospital or 30-day clinical outcomes was observed. However, at 6 months, patients in the sacubitril/valsartan arm suffered less hospitalization with HF (18% vs 38%, P=0.044) compared with patients in the ramipril arm. Other clinical outcomes at 6 months were similar between both groups. CONCLUSIONS: Sacubitril/valsartan in patients with STEMI and cardiogenic shock may be associated with improved clinical outcome at 6 months compared with ramipril. Larger randomized controlled trials with longer follow-up are recommended. AJCD
OBJECTIVES: To evaluate the safety and efficacy of sacubitril/valsartan versus ramipril in patients with STEMI and cardiogenic shock. METHODS: Patients who received primary percutaneous coronary intervention (PPCI) for STEMI complicated with cardiogenic shock were randomized 1:1 to sacubitril/valsartan versus ramipril after clinical stabilization. The primary outcome was major adverse cardiac events (MACE) at 30 days and 6 months. Secondary in-hospital clinical outcomes included recurrent shock, new or re-initiation of vasoactive medications, and acute kidney injury (AKI). All-cause death, cardiac death, hospitalization due to heart failure (HF), myocardial infarction (MI), and stroke were examined at 30 days and 6 months. Study ID 016-01-2018. RESULTS: 100 patients with STEMI and cardiogenic shock were included (mean age 54.7±10.3 years, 87% men). Initiation of sacubitril/valsartan and ramipril occurred at 38.18±18.44 versus 39.0±21.03 hours after stabilization, respectively. The primary outcome was similar between both groups at 30 days and 6 months. No difference in in-hospital or 30-day clinical outcomes was observed. However, at 6 months, patients in the sacubitril/valsartan arm suffered less hospitalization with HF (18% vs 38%, P=0.044) compared with patients in the ramipril arm. Other clinical outcomes at 6 months were similar between both groups. CONCLUSIONS: Sacubitril/valsartan in patients with STEMI and cardiogenic shock may be associated with improved clinical outcome at 6 months compared with ramipril. Larger randomized controlled trials with longer follow-up are recommended. AJCD
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