| BackgroundAcute myocardial infarction(AMI)is a clinically common acute cardio-vascular disease.The disease progresses rapidly and the sudden death rate is high.Acute myocardial infarction can be divided into two types according to the patient’s clinical symptoms and the dynamic evolution of the hospitalized ECG:Acute ST-segment elevation myocardial infarction(Acute ST-segment elevation myocardial infarction,STEMI)and non-ST-segment elevation myocardial infarction(Non-ST segment elevation myocardial infarction,NSTEMI).With the improvement of people’s quality of life,smoking,drinking,greasy diet,staying up late,lack of exercise and other bad habits gradually increased,The incidence of myocardial infarction in the population is getting higher and higher,and there is a trend of younger generation.Nowadays,the establishment of a chest pain center can allow patients with myocardial infarction to receive effective revascularization,However,since the damage of m-yocardial cells is irreversible,it will inevitably affect the systolic and diastolic functions of the heart,and then the heart function is damaged,and eventually progress to heart failure.So far,sacubitril/valsartan has been shown to be effective in the treatment of chronic heart failure in patients with reduced left ventricular ejection fraction(LVEF).It mainly inhibits enkephalinase,blocks angiotensin II receptors,and at the same time inhibits nerve and humoral regulation to achieve the role of sodium discharge diuresis and improve cardiac load.However,there is no clinical evidence for the use of sacubitril/valsartan in patients with NSTEMI.There has also been no study to compare sacubitril/valsartan with classical ACEI/ARB to improve ventricular remodeling after revascularization in patients with NSTEMI.This study temporarily observes the changes in cardiac function and prognosis of sacubitril/valsartan compared with classic ACEI/ARB in the treatment of patients with NSTEMI,and explores its application value in patients with NSTEMI.ObjectiveBy observing the changes in cardiac function and prognosis of sacubitril/valsartan in the treatment of patients with NSTEMI compared with classic ACEI/ARB,the value of its application in patients with NSTEMI was explored.methodsWe retrospectively included 120 patients with acute non-ST-segment elevation myocardial infarction who were admitted to the Five Cardiac Ward of the First Affiliated Hospital of Zhengzhou University from January 2019 to January 2020.All patients were revascularized after admission.According to the different anti-myocardial remodeling drugs in the treatment plan,they were divided into experimental group(n=64)and control group(n=56)The patients in the experimental group were treated with ARNI and the patients in the control group were treated with classical therapy(ACEI or ARB).All patients were treated for 6 months.Gender,age,hypertension,diabetes,hyperlipidemia,stroke history,smoking history,drinking history and other basic information of patients in the two groups were collected.Meanwhile,plasma NT-proBNP level and echocardiographic indicators(LVEDD,LAAPD,LVEF)of the first hospitalization were recorded.Both groups were treated for 6 months.The application value of sacubitril and valsartan in patients with NSTEMI was analyzed by comparing the observational indicators and out-of-hospital adverse events after 6 months’s follow-up.results1.Comparison of clinical baseline data between the two groups showed that there was no statistical significance in gender,age,hypertension,diabetes,hyperlipidemia,history of stroke,history of smoking and history of alcohol consumption between the two groups(P>0.05).2.Compared with before and after treatment,the level of NT-proBNP in the experimental group decreased compared with before treatment,while the left ventricular end-diastolic diameter、LVEF、left atrial diameter increased compared those with before treatment.The difference was statistically significant(P<0.05).3.In the control group,the level of NT-proBNP was decreased compared that with before treatment,and LVEF was increased compared that with before treatment,the difference was statistically significant(P<0.05).Compared with before treatment,there was no statistically significant difference in left atrial diameter and left ventricular end-diastolic diameter(P>0.05).4.Comparison of the difference between the experimental group and the control group before and after treatment,NT-proBNP level,left ventricular end diastolic diameter,and LVEF difference were higher than those of the control group,the difference was statistically significant(P<0.05),and the left atrium diameter was not statistically significant(P<0.05).5.Cox regression analysis and Kaplan-Meier survival curve showed that the incidence of out-of-hospital end points in experimental group was significantly lower than that in control group(P<0.05).conclusionFor patients with acute non-ST-segment elevation myocardial infarction with revascularization,sacubitril/valsartan can more significantly prevent and improve heart failure,and effectively prevent out-of-hospital adverse events. |
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