| Objective:This study is aimed to investigate the short-term efficacy of sacubitril valsartan(ARNI)in acute ST-segment elevation myocardial infarction patients combined with heart failure with mildly-reduced ejection fraction.Methods:1.A total of 1726 patients were collected retrospectively for patients admitted to the X Hospital of Jilin University cardiovascular units,from December 1,2020 to December 30,2021,the diagnosis was acute ST-segment elevation myocardial infarction(STEMI),of which 226 patients with heart failure with mildly-reduced ejection fraction(HFmr EF)were selected.All patients were strictly included and excluded.Participants with complete clinical data were followed up for 1 year(follow-up cutoff date:December 31,2022),of which 30 patients were lost or not reviewed regularly during the 1-year follow-up.Consequently,a total of 196 patients were enrolled in this study and were divided into ACEI/ARB group(53 patients)and ARNI group(143 patients)according to whether they took ACEI/ARB or ARNI.2.Clinical data were collected and analyzed for 196 patients,including age,sex,time from onset to admission,past history,length of stay,blood pressure at admission,heart rate,Killip grading,diagnosis,and post-admission laboratory examination,coronary angiography data,medication(ACEI/ARB,ARNI,aspirin,clopidogrel,statins,SGLT-2 inhibitors,furosemide,spironolactone,nitrates),Echocardiographic parameters within 48 hours of admission and follow-up data with major adverse cardiovascular event(MACEs:including hospitalization for recurrent angina,hospitalization for recurrent myocardial infarction,hospitalization for recurrent heart failure,recurrent revascularization,all-cause death),together with cardiac ultrasound data from patients reviewed at 1 month post-discharge.Statistical analysis was performed.3.In this clinical study,the data were collected and collated by Excel,and statistical processing of the data was carried out through SPSS25.0.For measurement data,The t-test is used to test the normal distribution and is expressed as±S;The rank sum test was used to test the non-normal distribution and was expressed as Md(P25,P75);theχ~2test or Fisher’s exact test was used for counting data and expressed as percentages;the binary logistic regression model was applied to screen the risk factors and protective factors for the occurrence of MACEs.The difference was considered statistically significant,P<0.05.Results:1.A total of 44 patients(30.77%)in the ARNI group had at least one MACE event while 12 patients(22.64%)in the ACEI/ARB group had MACE event,and the difference in the incidence of MACEs events between the two groups was not statistically significant(P>0.05).2.After 1 month follow-up,ARNI and ACEI/ARB both showed statistically significant differences in LVEF compared to the baseline data(P<0.05)and there is no significant difference in the improvement between the two groups(P>0.05);while no statistically significant differences in LAd and LVEDd compared to the baseline data(P>0.05).3.After a multifactorial regression analysis of risk factors for MACEs,the results showed that PCI treatment was an independent protective factor for the occurrence of MACEs(P<0.001,OR=0.151,95%CI:0.059-0.389).Conclusions:1.In the real world,for patients with acute ST-segment elevation myocardial infarction and HFmr EF,clinicians tend to use ARNI for patients with relatively lower LVEF.2.The application of ACEI/ARB and ARNI can both improve the cardiac function in patients with acute ST-segment elevation myocardial infarction and HFmr EF,and they have similar level of improvement. |
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