scholarly journals Effects and Safety of Sacubitril/Valsartan for Patients with Myocardial Infarction: A Systematic Review and Meta-Analysis

2022 ◽  
Vol 2022 ◽  
pp. 1-8
Author(s):  
Lang Liu ◽  
Xiaofang Ding ◽  
Yaxiang Han ◽  
Jianfeng Lv
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Systematic Review ◽  
Acute Myocardial Infarction ◽  
Meta Analysis ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Patients With Heart Failure ◽  
Valsartan Group ◽  
The Difference

Patients who develop heart failure (HF) after an acute myocardial infarction (AMI) are at higher risk of adverse fatal and nonfatal outcomes. Studies have shown sacubitril/valsartan can further reduce the risk of cardiovascular death or hospitalization for heart failure by 20% compared with enalapril. At the same time, its tolerance and safety are better. However, the current evidence regarding the efficacy of sacubitril/valsartan in patients with heart failure after acute myocardial infarction is controversial. To assess the effect of sacubitril/valsartan on heart failure after acute myocardial infarction, we conducted a systematic review of the literature and a meta-analysis of existing randomized clinical trials. Meta-analysis of randomized controlled trails is used where data are collected from PubMed, the Cochrane library, Embase, and Web of Science. Data about sacubitril/valsartan were available from 5 studies. Forest plots showed that the sacubitril/valsartan group had a 299% higher value of sacubitril/valsartan to the control group (MD = 2.99%, 95% CI: 2.01, 3.96, I2 = 78%, P < 0.00001 , Figure 2), and the difference was statistically significant. Forest plots showed that the sacubitril/valsartan group had a 531% lower value of LVEF to the control group (MD = −5.31%, 95% CI: −7.36, −3.26, I2 = 91%, P < 0.00001 , Figure 2), and the difference was statistically significant. Forest plots showed that the sacubitril/valsartan group had a 133% lower value of NT-proBNP to the control group (MD = −1.33%, 95% CI: −1.54, −1.12, I2 = 96%, P < 0.00001 , Figure 3). Forest plots showed that the sacubitril/valsartan group had a 49% lower risk of heart failure to the control group (MD = 0.49, 95% CI: 0.27, 0.89, I2 = 0%, P = 0.02 , Figure 3). The patients in experimental showed an obviously lower OR of MACE (OR = 0.47, 95% CI: 0.27, 0.82, P = 0.007 , Figure 3). The data were statistically significant. We have observed that for patients with heart failure after acute myocardial infarction, early administration of sacubitril/valsartan can significantly reduce the incidence of heart rate, left ventricular ejection fraction, NT-proBNP, and MACE. Our meta-analysis suggests that taking sacubitril/valsartan is relatively safe and effective, especially if started early after acute myocardial infarction.

scholarly journals Prevalence and Prognosis of HFimpEF Developed From Patients With Heart Failure With Reduced Ejection Fraction: Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Yibo He ◽  
Yihang Ling ◽  
Wei Guo ◽  
Qiang Li ◽  
Sijia Yu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Ejection Fraction ◽  
Lower Risk ◽  
Meta Analysis ◽  
Left Ventricular Ejection ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients ◽  
Risk Of Mortality ◽  
Patients With Heart Failure

Background: Heart failure with improved ejection fraction (HFimpEF) is classified as a new type of heart failure, and its prevalence and prognosis are not consistent in previous studies. There is no systematic review and meta-analysis regarding the prevalence and prognosis of the HFimpEF.Method: A systematic search was performed in MEDLINE, EMBASE, and Cochrane Library from inception to May 22, 2021 (PROSPERO registration: CRD42021260422). Studies were included for analysis if the prognosis of mortality or hospitalization were reported in HFimpEF or in patients with heart failure with recovered ejection fraction (HFrecEF). The primary outcome was all-cause mortality. Cardiac hospitalization, all-cause hospitalization, and composite events of mortality and hospitalization were considered as secondary outcomes.Result: Nine studies consisting of 9,491 heart failure patients were eventually included. During an average follow-up of 3.8 years, the pooled prevalence of HFimpEF was 22.64%. HFimpEF had a lower risk of mortality compared with heart failure patients with reduced ejection fraction (HFrEF) (adjusted HR: 0.44, 95% CI: 0.33–0.60). HFimpEF was also associated with a lower risk of cardiac hospitalization (HR: 0.40, 95% CI: 0.20–0.82) and the composite endpoint of mortality and hospitalization (HR: 0.56, 95% CI: 0.44–0.73). Compared with patients with preserved ejection fraction (HFpEF), HFimpEF was associated with a moderately lower risk of mortality (HR: 0.42, 95% CI: 0.32–0.55) and hospitalization (HR: 0.73, 95% CI: 0.58–0.92).Conclusion: Around 22.64% of patients with HFrEF would be treated to become HFimpEF, who would then obtain a 56% decrease in mortality risk. Meanwhile, HFimpEF is associated with lower heart failure hospitalization. Further studies are required to explore how to promote left ventricular ejection fraction improvement and improve the prognosis of persistent HFrEF in patients.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260422, identifier: CRD42021260422.

scholarly journals Carvedilol versus metoprolol succinate in the treatment of patients with heart failure with reduced ejection fraction and patients with acute myocardial infarction

2021 ◽  
Vol 2021 (1) ◽  
pp. 36-39
Author(s):  
E.Ya. Nikolenko ◽  
◽  
K.V. Vovk ◽  
O.L. Pavlova ◽  
O.O. Salun ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Ejection Fraction ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Metoprolol Succinate ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Choosing the best drug for the treatment of cardiac patients remains one of the most important aspects of medical practice. The purpose of this review is to select the optimal beta-blocker for the treatment of patients with chronic heart failure and patients with acute myocardial infarction by comparing the efficacy of carvedilol and metoprolol succinate, as both drugs significantly reduce mortality rates and reduce hospitalization. The results of meta-analyzes, randomized trials comparing the efficacy of carvedilol and metoprolol succinate in the treatment of patients with heart failure with reduced ejection fraction and patients with acute myocardial infarction were analyzed. Conflicting data received. According to the study “Effect of carvedilol vs metoprolol succinate on mortality in heart failure with reduced ejection fraction”, a meta-analysis published in the American Journal of Cardiology in 2013, carvedilol is significantly more effective than metoprolol succinate in treatment of patients with heart failure with reduced ejection fraction and patients with acute myocardial infarction, while meta-analyzes of 2015 and 2017 showed no preference for carvedilol over metoprolol succinate. Based on the results, concluded that the data obtained is not sufficient to argue that carvedilol is more effective than metoprolol succinate for this category of patients in terms of reducing the risk of all-cause mortality, cardiovascular mortality, and reducing hospitalization. This problem requires further extensive research.

scholarly journals Association between hyperlipidemia and mortality after incident acute myocardial infarction or acute decompensated heart failure: a propensity score matched cohort study and a meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e028638 ◽  
Author(s):  
Mohammed Yousufuddin ◽  
Paul Y Takahashi ◽  
Brittny Major ◽  
Eimad Ahmmad ◽  
Hossam Al-Zubi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Systematic Review ◽  
Acute Myocardial Infarction ◽  
Propensity Score ◽  
Acute Decompensated Heart Failure ◽  
Meta Analysis ◽  
Decompensated Heart Failure ◽  
Lower Mortality ◽  
All Cause Mortality

ObjectiveTo examine the effect of HLP, defined as having a pre-existing or a new in-hospital diagnosis based on low density lipoprotein cholesterol (LDL-C) level ≥100 mg/dL during index hospitalisation or within the preceding 6 months, on all-cause mortality after hospitalisation for acute myocardial infarction (AMI) or acute decompensated heart failure (ADHF) and to determine whether HLP modifies mortality associations of other competing comorbidities. A systematic review and meta-analysis to place the current findings in the context of published literature.DesignRetrospective study, 1:1 propensity-score matching cohorts; a meta-analysis.SettingLarge academic centre, 1996–2015.ParticipantsHospitalised patients with AMI or ADHF.Main outcomes and measuresAll-cause mortality and meta-analysis of relative risks (RR).ResultsUnmatched cohorts: 13 680 patients with AMI (age (mean) 68.5 ± (SD) 13.7 years; 7894 (58%) with HLP) and 9717 patients with ADHF (age, 73.1±13.7 years; 3668 (38%) with HLP). In matched cohorts, the mortality was lower in AMI patients (n=4348 pairs) with HLP versus no HLP, 5.9 versus 8.6/100 person-years of follow-up, respectively (HR 0.76, 95% CI 0.72 to 0.80). A similar mortality reduction occurred in matched ADHF patients (n=2879 pairs) with or without HLP (12.4 vs 16.3 deaths/100 person-years; HR 0.80, 95% CI 0.75 to 0.86). HRs showed modest reductions when HLP occurred concurrently with other comorbidities. Meta-analyses of nine observational studies showed that HLP was associated with a lower mortality at ≥2 years after incident AMI or ADHF (AMI: RR 0.72, 95% CI 0.69 to 0.76; heart failure (HF): RR 0.67, 95% CI 0.55 to 0.81).ConclusionsAmong matched AMI and ADHF cohorts, concurrent HLP, compared with no HLP, was associated with a lower mortality and attenuation of mortality associations with other competing comorbidities. These findings were supported by a systematic review and meta-analysis.

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