Sacubitril/ Valsartan wasn't effective in controlling heart attack comparing to ramipril: PARADISE MI Trial

Myocardial infarction, commonly called a heart attack is an extremely dangerous condition caused by a lack of blood flow to your heart muscle. The lack of blood flow can occur because of many different factors but is usually related to a blockage in one or more of arteries. The chest pain is often severe, but some people experience minor pain, similar to indigestion.

The PARADISE-MI trial showed that sacubitril/valsartan did not reduce the primary endpoint in a contemporary enriched AMI population, compared with ramipril.

The trial is published in American College of Cardiology journal.

The trial assesses the efficacy and safety of sacubitril/valsartan compared with ramipril in a contemporary acute myocardial infarction population. Eligible patients were randomized in a 1:1 fashion where 2,830 in sacubitril/valsartan (target dose 97/103 mg twice a day) or 2,831 ramipril (target 5 mg twice a day).

The primary outcome of cardiovascular (CV) death, first Heart Failure (HF) hospitalization, or outpatient Heart Failure for sacubitril/valsartan vs. ramipril, was: 11.9% vs. 13.2%. CV death: 5.9% vs. 6.7% (p = 0.20); HF hospitalization was 6% vs. 6.9% (p = 0.17). Secondary outcomes for sacubitril/valsartan vs. ramipril showed CV death/MI/stroke: 11.1% vs. 12.3% (p = 0.18). All-cause mortality was also 7.5% vs. 8.5% (p = 0.16). Total HF hospitalization, outpatient HF events, and CV mortality: 8.4 vs.10.1/100 patient-years (p = 0.02). Hypotension: 28.4% vs. 22.0% (p < 0.05).

The results of this trial indicate that the combination sacubitril/valsartan did not reduce the primary endpoint in a contemporary enriched acute myocardial infarction population, compared with ramipril. These are interesting findings and add to the available data with angiotensin receptor-neprilysin inhibitors.

Reference: https://www.acc.org/latest-in-cardiology/clinical-trials/2021/05/14/01/22/paradise-mi