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Comparison of Efficacy and Safety of Sacubitril/Valsartan and Perindopril in Acute Myocardial Infarction Complicated by Post Surgery Heart Failure

Author(s): Leyi Hu*, H. Zhang and Jinglin Cheng
Department of Internal Emergency, The Second Affiliated Hospital of Anhui Medical University, Anhui Hefei 230601, China

Correspondence Address:
Leyi Hu, Department of Internal Emergency, The Second Affiliated Hospital of Anhui Medical University, Anhui Hefei 230601, China, E-mail:

Myocardial necrosis induced by acute and persistent ischemia and hypoxia in the coronary arteries delineates acute myocardial infarction. In severe instances, heart failure can ensue. In the realm of clinical practice, the principal modalities employed to address acute myocardial infarction encompass percutaneous coronary intervention surgery and pharmacological treatment. It has been reported that post-percutaneous coronary intervention patients with acute myocardial infarction often experience concomitant heart failure, which is a significant contributor to postoperative mortality. Therefore, actively seeking effective medications for treating patients with post-percutaneous coronary intervention heart failure is of crucial importance for improving patient prognosis and promoting overall patient recovery. The purpose of this study is to explore the applicability and efficacy of sacubitril/valsartan in individuals with post-percutaneous coronary intervention heart failure subsequent to acute myocardial infarction. For the duration of this investigation, a cohort comprising 106 individuals with a verified acute myocardial infarction diagnosis who underwent percutaneous coronary intervention surgery between May 2020 and February 2023 was meticulously chosen. Within this sample, a subset of 53 patients was subjected to conventional therapy alongside perindopril, constituting the control group. Simultaneously, an additional 53 patients were administered sacubitril/valsartan as part of their treatment and were designated as the observation group. Color Doppler ultrasound was harnessed to measure various parameters before and after treatment, including left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular fractional shortening, interventricular septal thickness at diastole, left ventricular mass index, and left ventricular ejection fraction. Additionally, myocardial injury biomarkers such as N-terminal B-type natriuretic peptide prosoma, cardiactrofonin I, and creatine kinase isozyme were measured using a multifunctional immunoassay analyzer to evaluate myocardial injury prior and subsequent to treatment. Hemodynamic parameters, encompassing blood pressure, heart rate, and the average hourly urine output over a 24 h period, were subjected to comparative analysis between the two groups, both pre- and post-treatment. Moreover, the evaluation of patients' quality of life under distinct medication regimens was carried out utilizing the Kansas City cardiomyopathy questionnaire, while clinical effectiveness was documented. The occurrence of adverse cardiovascular events such as angina, dry cough, hypotension, hyperkalemia, dyspnea, as well as readmission within 3 mo of treatment was also compared between the two groups. The results showed no statistically significant differences (p>0.05) in cardiac function indicators (LVEDD, LVEDS, LVFS, etc.), myocardial injury biomarkers (NT-proBNP, cTnI, CK-MB), blood pressure, heart rate, and urine output between the two groups prior to treatment. However, subsequent to treatment, the observation group exhibited lower levels of LVEDD, LVEDS, IVST, LVMI, NT-proBNP, cTnI, CK-MB and higher levels of LVFS and LVEF compared to the control group, with the differences holding statistical significance (p<0.05). Moreover, the observation group displayed higher levels of systolic and diastolic blood pressure, lower levels of heart rate, and more urine output compared to the control group, and the differences were statistically significant (p>0.05). Additionally, no statistically notable dissimilarities were observed in Kansas City cardiomyopathy questionnaire scores between the two cohorts prior to the initiation of pharmacological interventions. Notwithstanding, subsequent to divergent medicinal therapies, the observation group exhibited elevated Kansas City cardiomyopathy questionnaire scores in relation to the control group. Moreover, the clinical effectiveness of the observation group (96.23 %) surpassed that of the control group (84.90 %) to a substantial degree, with a statistically significant distinction (p<0.05) between the two. No statistically significant variances (p>0.05) were detected in the incidence of adverse reactions between the two groups, but the rate of readmission in the observation group was inferior to that observed in the control group, showcasing a statistically significant contrast (p<0.05). Compared to treatment with perindopril, the use of sacubitril/valsartan efficaciously ameliorates cardiac function, attenuates myocardial injury, improves hemodynamics, enhances the patient quality of life, and demonstrates better clinical efficacy, as well as a lower readmission rate for patients with acute myocardial infarction complicated with post- percutaneous coronary intervention heart failure.

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