■已广泛报道了舒巴曲缬沙坦可降低心力衰竭(HF)患者的心血管死亡风险并改善左心室重构。然而,沙库必曲-缬沙坦对急性心肌梗死(AMI)患者的疗效仍存在争议.因此,我们进行了这项荟萃分析,目的是研究沙库巴曲-缬沙坦是否能逆转AMI患者直接经皮冠状动脉介入治疗(PPCI)后的左心室重构并减少心血管不良事件.
■两名研究人员从PubMed独立检索了相关文献,Embase,科克伦图书馆,中国国家知识基础设施(CNKI),和万方数据库。检索时间从开始到2023年6月1日。纳入并分析符合纳入标准的随机对照试验(RCTs)。
■总共,该荟萃分析包括21个RCT,涉及2442例接受PPCI进行血运重建的AMI患者。Meta分析显示,与血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体阻滞剂(ARB)相比,Sacubitril-缬沙坦治疗AMI患者PPCI术后可显著降低左心室舒张末期内径(LVEDD)(加权平均差(WMD)-3.11,95CI:-4.05~-2.16,p<0.001),左心室舒张末期容积(LVEDV)(WMD-7.76,95CI:-12.24~-3.27,p=0.001),左心室收缩末期容积(LVESV)(WMD-6.80,95CI:-9.45~-4.15,p<0.001)和左心室收缩末期容积(LVESD)(WMD-2.53,95CI:-5.30-0.24,p<0.001)。根据沙库巴曲-缬沙坦的剂量进行亚组分析得出相似的结果。同时,使用沙库巴曲-缬沙坦治疗的PPCI患者显示主要不良心脏事件(MACE)的风险较低(OR=0.36,95CI:0.28-0.46,p<0.001),心肌梗死(OR=0.54,95CI:0.30-0.98,p=0.041)和HF(OR=0.35,95CI:0.26-0.47,p<0.001)而不增加肾功能不全的风险,高钾血症,或有症状的低血压。同时,左心室射血分数(LVEF)的变化(WMD3.91,95CI:3.41-4.41,p<0.001),6min步行试验(6MWT)(WMD43.56,95CI:29.37~57.76,p<0.001)和NT-proBNP水平(WMD-130.27,95CI:-159.14~-101.40,p<0.001)均有统计学意义。
■总而言之,我们的荟萃分析表明,与ACEI/ARB相比,沙库巴曲-缬沙坦可能优于逆转左心室重构,改善心脏功能,并有效降低MACE的风险,心肌再梗死,在随访期间,PPCI术后AMI患者的HF并未增加包括肾功能不全在内的不良反应的风险,高钾血症,和症状性低血压。
UNASSIGNED: Sacubitril-valsartan has been widely reported for reducing the risk of cardiovascular death and improving left ventricular remodeling in patients with heart failure (HF). However, the effect of sacubitril-valsartan in patients with acute myocardial infarction (AMI) remains controversial. Therefore, we conducted this meta-analysis to investigate whether sacubitril-valsartan could reverse left ventricular remodeling and reduce cardiovascular adverse events in AMI patients after primary percutaneous coronary intervention (PPCI).
UNASSIGNED: Two researchers independently retrieved the relevant literature from PubMed, Embase, The Cochrane Library, China National Knowledge Infrastructure (CNKI), and the Wanfang database. The retrieval time was limited from inception to 1 June 2023. Randomized controlled trials (RCTs) meeting the inclusion criteria were included and analyzed.
UNASSIGNED: In total, 21 RCTs involving 2442 AMI patients who underwent PPCI for revascularization were included in this meta-analysis. The meta-analysis showed that compared with the angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), sacubitril-valsartan treatment in AMI patients after PPCI significantly reduced left ventricular end-diastolic dimension (LVEDD) (weighted mean difference (WMD) -3.11, 95%CI: -4.05∼-2.16, p < 0.001), left ventricular end-diastolic volume (LVEDV) (WMD -7.76, 95%CI: -12.24∼-3.27, p = 0.001), left ventricular end-systolic volume (LVESV) (WMD -6.80, 95%CI: -9.45∼-4.15, p < 0.001) and left ventricular end-systolic dimension (LVESD) (WMD -2.53, 95%CI: -5.30-0.24, p < 0.001). Subgroup analysis according to the dose of sacubitril-valsartan yielded a similar result. Meanwhile, PPCI patients using sacubitril-valsartan therapy showed lower risk of major adverse cardiac events (MACE) (OR = 0.36, 95%CI: 0.28-0.46, p < 0.001), myocardial reinfarction (OR = 0.54, 95%CI: 0.30-0.98, p = 0.041) and HF (OR = 0.35, 95%CI: 0.26-0.47, p < 0.001) without increasing the risk of renal insufficiency, hyperkalemia, or symptomatic hypotension. At the same time, the change of LV ejection fraction (LVEF) (WMD 3.91, 95%CI: 3.41-4.41, p < 0.001), 6 min walk test (6MWT) (WMD 43.56, 95%CI: 29.37-57.76, p < 0.001) and NT-proBNP level (WMD -130.27, 95%CI: -159.14∼-101.40, p < 0.001) were statistically significant.
UNASSIGNED: In conclusion, our meta-analysis indicates that compared with ACEI/ARB, sacubitril-valsartan may be superior to reverse left ventricular remodeling, improve cardiac function, and effectively reduce the risk of MACE, myocardial reinfarction, and HF in AMI patients after PPCI during follow-up without increasing the risk of adverse reactions including renal insufficiency, hyperkalemia, and symptomatic hypotension.