Int J Cardiol. 2025 Jul 3:133543. doi: 10.1016/j.ijcard.2025.133543. Online ahead of print.
ABSTRACT
BACKGROUND: Angiotensin-neprilysin inhibition (ARNI) reduces mortality and morbidity in chronic heart failure, but its efficacy in acute myocardial infarction (MI) remains uncertain. This study compares ARNI versus angiotensin receptor blockers (ARB) in acute MI patients.
METHODS AND RESULTS: This cohort study used a target trial emulation approach to include acute MI patients between 2019 and 2022 from the Tianjin Health and Medical Data Platform, China. Eligible patients newly prescribed ARB or ARNI during hospitalization were matched 1:1 using propensity scores. The primary outcome was all-cause mortality at 30 days and 1 year. Time-dependent hazard ratio (HR) was used to the explore potential benefit window of ARNI. The matched cohort included 10,480 patients (5240 per group) for intention-to-treat analysis, with 701 deaths (6.7 %) recorded. Compared with ARB, ARNI was significantly associated with a lower 30-day mortality risk (HR: 0.68, 95 % confidence interval [CI]: 0.52-0.88) but showed no association with 1-year mortality (HR: 0.99, 95 % CI: 0.85-1.14). Exploratory analysis indicates that the beneficial effect of ARNI extends to 60 days (HR: 0.68, 95 % CI: 0.52-0.88). No significant differences were observed for recurrent MI (HR: 0.98, 95 % CI: 0.87-1.10) or stroke (HR: 1.15, 95 % CI: 0.98-1.35). Subgroup analysis indicated a particular benefit of ARNI in heart failure patients at 60 days (HR: 0.75, 95 % CI: 0.58-0.96).
CONCLUSIONS: In patients with acute MI, ARNI was associated with improved survival compared to ARB within the first 60 days. This survival benefit diminished over time, with no significant difference observed at 1-year follow-up.
PMID:40617484 | DOI:10.1016/j.ijcard.2025.133543