The Effects Of Sacubitril/valsartan On Major Adverse Cardiovascular Events And Related Risk Factor Analysis In Patients With Acute Myocardial Infarction

【 Objective 】 This study investigates the effects of Sacubitril/Valsartan(ARNI)on major adverse cardiovascular events(MACEs)and related risk factor analysis in patients with acute myocardial infarction(AMI).【 Methods 】 A total of 315 patients with AMI admitted to the Cardiovascular Department of the First Affiliated Hospital of Dali University from June 2021 to January 2022 were divided into an experimental group(ARNI group)of 172 patients and a control group(ACEI/ARB group)of 143 patients according to the medication method.In addition to receiving routine secondary prevention drugs for coronary heart disease,the experimental group was treated with sacubitril/valsartan sodium tablets,while the control group was treated with traditional drugs(angiotensin-converting enzyme inhibitors/angiotensin receptor blockers).After 12 months of follow-up,the two groups of patients were observed for their heart function,MACEs,and other conditions,and the related risk factors for MACEs in AMI patients were analyzed.【Results】1.General information: A total of 315 patients with acute myocardial infarction(AMI)were included in this study,with a mean age of 59.40±10.91 years.After followup,35 patients experienced major adverse cardiovascular events(MACEs),with a MACE incidence of 11.1%.There were no statistically significant differences in general information such as gender,age,diabetes,and hypertension between the two groups(P>0.05).2.Efficacy analysis: The incidence of heart failure(HF)in the ARNI group at admission was 30.8%,which was higher than that in the ACEI/ARB group(4.9%)(P<0.05).The efficacy results of different treatment regimens showed that the incidence of HF in the ARNI group after treatment was 20.6%,while that in the ACEI/ARB group was 4.7%.Further analysis showed that there were differences in ΔEF(change after treatment-before treatment)between different treatment regimens,and the proportion of patients with ΔEF>10% in the ARNI group was 76.9%,which was much higher than that in the ACEI/ARB group(23.1%)(P<0.05).The medication results of the ARNI group showed a positive correlation between medication dose and ΔEF change(r=0.235).The incidence of MACEs in the ARNI group was 12.2%,while that in the ACEI/ARB group was 9.7%,and there was no significant difference between the two groups(P>0.05).The absolute difference in ΔTC(total cholesterol)before and after treatment in the ARNI group(1.05±1.38)was higher than that in the ACEI/ARB group(0.48±1.6),and the difference was statistically significant(P<0.05).3.Correlation and risk factor analysis: The prevalence of hypertension in AMI patients with three-vessel disease was 59.5%,which was significantly higher than that in patients with single or double-vessel disease(P<0.05).Univariate analysis showed that there was a significant difference in the admission BNP levels among AMI patients with different degrees of coronary artery disease(P<0.05),and the comparison of pairwise groups showed that BNP levels in patients with three-vessel disease(303.0±28.8 mmol/L)were significantly higher than those in patients with single or double-vessel disease(P<0.05).Logistic regression analysis indicated that age>50 years and hypertension(OR=1.930,P=0.040;OR=1.763,P=0.025)were independent risk factors for multi-vessel coronary artery disease.ST-elevation myocardial infarction(STEMI)and triglycerides(TG)(OR=3.430,P=0.007;OR=1.457,P=0.034)were independent risk factors for admission EF<50% in AMI patients.Cox proportional hazards regression analysis showed that admission EF>50% and normal BNP were protective factors for MACEs in AMI patients(HR=0.322,P=0.006;HR=0.376,P=0.010).4.Survival rate and survival curve: Survival curves were plotted for different treatment regimens,and as the follow-up time increased,the survival curves of the two groups of patients became more distinct,with higher survival rates in the ARNI group than in the ACEI/ARB group.【Conclusion】1.Compared with ACEI/ARB drugs,long-term use of sacubitril-valsartan can effectively improve cardiac function and lipid status in AMI patients,and the closer the dose of sacubitril-valsartan is to the target dose,the stronger the improvement effect on cardiac function.2.Early treatment of hypertension,high TG,admission EF reduction,and elevated admission BNP in high-risk populations with antihypertensive,lipid-lowering,and heart failure improvement therapy will be beneficial for the long-term prognosis improvement of AMI patients.3.There was no significant difference in the incidence of MACEs between the two groups of patients in the short term,but as time went on,sacubitril-valsartan had a progressive improvement effect on the long-term survival rate and occurrence of MACEs in AMI patients.