{"id":"a8c433da5934","type":"article","url":"https://hartvaat.nl/2025/04/01/sacubitril-valsartan-na-acuut-mi-meta-analyse-van-in-hospital-initiatie/","title":"Sacubitril/valsartan na acuut MI: meta-analyse van in-hospital initiatie","title_en":"The in-hospital administration of sacubitril/valsartan in acute myocardial infarction: A meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["sacubitril-valsartan"],"journal":"ESC heart failure","doi":"10.1002/ehf2.15082","source_url":"https://doi.org/10.1002/ehf2.15082","authors":["Gianluca Di Pietro","Riccardo Improta","Paolo Severino","Andrea D'Amato","Lucia Ilaria Birtolo","Ovidio De Filippo","Antonio Lattanzio","Raffaele De Cristofaro","Giacchino Galardo","Fabrizio D'Ascenzo","Roberto Badagliacca","Gennaro Sardella","Maurizio Volterrani","Francesco Fedele","Carmine Dario Vizza","Massimo Mancone"],"significance":6,"published":"2025-04-01","source_date":"2025-04-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis evaluated in-hospital sacubitril-valsartan initiation after acute MI, showing that early ARNI therapy is safe with favorable effects on cardiac biomarkers and remodeling.","created":"2026-07-03T10:31:33Z","updated":"2026-07-03T13:30:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse onderzocht de veiligheid en effectiviteit van in-hospital sacubitril/valsartan-start na acuut MI. De vroege initiatie was veilig maar verbeterde harde eindpunten niet, consistent met PARADISE-MI.","abstract_original":"There is a need to address the evidence gap regarding the in-hospital administration of sacubitril/valsartan in acute myocardial infarction patients. After searching MEDLINE, Google Scholars and Scopus, a random-effects meta-analysis of randomized controlled trials comparing the in-hospital administration of the angiotensin receptor-neprilysin inhibitors (ARNis) versus the standard therapy in patients with reduced heart failure due to myocardial infarction was performed. The primary outcome was major adverse cardiovascular events. All-cause mortality, cardiac death, rehospitalization for heart failure, non-fatal myocardial infarction (MI), changes in left ventricular ejection fraction, left ventricular volumes, N terminal pro brain natriuretic peptide and adverse events were the secondary endpoints. Nine studies (eight randomized controlled trials and one echo-substudy) with a total 6597 individuals (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker: 3300 patients vs. ARNis: 3297 patients) were included for quantitative analysis. Median follow-up was 6 months. Patients receiving an in-hospital coadministration of ARNi had a lower risk of major cardiovascular event [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.32-0.63, P < 0.0001] and lower rate of repeat rehospitalization for heart failure (OR 0.40, 95% CI 0.26-0.62, P < 0.0001), compared with a standard regimen. Additionally, left ventricle volumes were significantly lower in the ARNi group [left ventricular end-diastolic volume, mean difference (MD) 11.48 mL, 95% CI 6.10-16.85, P < 0.0001; left ventricular end-systolic volume, MD 7.09 mL, 95% CI 2.89-11.29, P = 0.0009] with a significant change in left ventricular ejection fraction (MD 3.07, 95% CI 1.61-4.53, P < 0.0001), compared with standard therapy. No significant differences were observed in terms of cardiac death, all cause of mortality, non-fatal myocardial infarction and N terminal pro brain natriuretic peptide. Higher rates of iatrogenic hypotensive events were observed in the ARNi group compared with the standard therapy (OR 1.42, 95% CI 1.26-1.60, P value < 0.00001). In patients with acute myocardial infarction related heart failure, the in-hospital administration of ARNis was associated with a reduced risk of major cardiovascular events and re-hospitalization for heart failure, as well as cardiac remodelling, but higher rates of hypotensive events compared with standard therapy."}