Observation On The Clinical Efficacy Of Sacubitril/valsartan In The Treatment Of Heart Failure After Acute Myocardial Infarction

Objective: To observe whether the therapeutic effect of sacubitril/valsartan sodium(ARNi)on heart failure(HF)after emergency percutaneous coronary intervention(PCI)is better than enalapril.Methods: From 2019 to 2020,60 patients who were diagnosed as AMI and HF in the emergency department of Handan Central Hospital(East District)whose killip grades were II to III and who agreed to undergo emergency PCI were consecutively enrolled.According to the random number table,60 cases were equally divided into two groups: enalapril control group(group A)and sacubitril/valsartan test group(group B).After operation,on the basis of routine antithrombotic therapy and risk factors control,group A was treated with enalapril,which was gradually titrated to the maximum tolerated dose,while group B was treated with sacubitril valsartan sodium,which was gradually titrated to the maximum tolerated dose.And during the follow-up after discharge,the drug dose was adjusted according to blood pressure and other conditions.Basic information was collected after admission: age,gender,height,risk factors,cardiac function(Killip classification),troponin,TIMI blood flow classification,infarction location.During hospitalization,weight,body mass index(BMI),blood pressure(BP)were measured,1 month and 3 months after discharge,respectively;and echocardiography:1 month and 3 months after discharge respectively;cardiac color Doppler ultrasound:LVESD,LVEF,LVEDD and LVFS;and venous blood was collected to measure plasma N-terminal pro brain natriuretic peptide(NT-pro BNP),creatinine(Cr),uric acid(UA),potassium(K),and sodium(Na).Results: No statistical difference was found between the baseline data of the two groups including age,gender,height,risk factors,cardiac function(Killip classification),troponin,TIMI blood flow classification,infarction location and drug treatment after admission(P>0.05).At admission,there were no differences and statistical significance in body weight,BMI,BP,LVEF,LVEDD,LVESD,LVFS,NT-pro BNP,Cr,UA,K,between the two groups(P>0.05).Patients in the two groups have received standardized treatment and regular medication to control their clinical symptoms and were reexamined in the outpatient clinic at 1 month and 3 months after discharge.The comparison results showed that compared with that before treatment,NT-pro BNPs in the two groups after treatment for 1 month and 3months both showed a significant decrease(P<0.001),and the decrease in NT-pro BNP in the ARNi group was greater than that in the enalapril group(P <0.001);in terms of echocardiography,compared with that before treatment,the LVEF in the two groups after treatment for 1 month and 3months were improved(P<0.001),and the improvements of LVEF in the sacubitril/valsartan group was greater than that in the enalapril group(P<0.005).And the LVEDD and LVESD in the groups after treatment for 1month and 3 months were improved as well(P<0.001).The difference in LVEDD and LVESD after treatment for 1 month(P=0.091,P=0.066)was statistically insignificant while that after treatment for 3 month(P <0.005)was statistically significant with demonstration that the improvements in the ARNi group was greater than that in the enalapril group(P<0.005).Compared with that before treatment,the LVFS in the enalapril group had no change after 1 month of treatment(P=0.108),but after 3months of treatment,the difference was statistically significant(P=0.039).In the ARNi group,the difference in LVFS before treatment and after 1month or 3 months of treatment was statistically significant(P<0.05);the BPs of the two groups both decreased after treatment for 1 month but no difference was found between the two groups(P>0.05).Compared with those after 1 month of treatment,no obvious changes were found in either systolic blood pressure(SBP)or diastolic blood pressure(DBP)after 3months of treatment,and the difference between the groups was statistically iinsignificant(P>0.05).There was no change in body weight and BMI before and after 1 month of treatment,and the difference between the two groups was not statistically significant(P>0.05).Compared with those before treatment,the body weight and BMI after treatment for 3months of the ARNi group were lower(P<0.05).However,compared with the enalapril group,there was no significant difference(P>0.05);in terms of biochemical indicators,there was no significant difference in Cr,UA,K,and Na in both groups before and after 1 and 3 months of treatment(P>0.05),and there was no statistically significant difference between the two groups(P>0.05).No obvious liver and kidney function damage and drug discontinuation due to intolerable side effects were observed in patients in both groups.Conclusion: For patients with heart failure after acute myocardial infarction who received emergency PCI,postoperative ARNi treatment is better than enalapril in improving cardiac function and prognosis,and reversing ventricular remodeling;but both ARNi and enalapril can reduce the risk of chronic heart failure for patients;no significant hypotension or hypotensive shock have been found during the treatment of ARNi and enalapril;Both ARNi and enalapril have good drug tolerance,and no cases withdrawn due to cardiovascular events and drug side effects.