Sacubitril-Valsartan not superior to Ramipril in acute MI setting, finds PARADISE MI trial
In patients with symptomatic heart failure, sacubitril-valsartan has been found to reduce the risk of hospitalization and death from cardiovascular causes more effectively than an angiotensin-converting–enzyme inhibitor (ACE-I). But the same benefit was not reproduced when both the classes were compared in an acute myocardial infarction (MI) setting by Pfeffer et al.
The results of PARADISE MI trial published today in NEJM have shown that Sacubitril–valsartan is not associated with a significantly lower incidence of death from cardiovascular causes or incident heart failure than ramipril among patients with acute MI.
The landmark PARADIGM-HF showed that sacubitril–valsartan led to better outcomes than an angiotensin-converting–enzyme (ACE) inhibitor in patients with stable NYHA class II or III heart failure with a left ventricular ejection fraction of 0.40 or lower.
In this issue of the NEJM, Pfeffer et al explored whether the benefits of angiotensin receptor–neprilysin inhibition over ACE inhibition would extend back from stable chronic heart failure into the context of acute myocardial infarction.
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