| Objective:This article AMIs to observe and analyze the efficacy and safety of sacubitril/valsartan in the early treatment of patients undergoing elective PCI after acute myocardial infarction,and explore the influencing factors of adverse cardiovascular events in AMI patients,providing a basis for clinical medication in the postoperative treatment of acute myocardial infarction with elective PCI.Methods:This study used a random sampling method to select acute myocardial infarction patients admitted to the cardiology department of Dali University First Affiliated Hospital from January 2021 to September 2022.After inclusion and exclusion criteria were applied,120 AMI patients undergoing elective PCI were finally included and divided into an experimental group(ARNI group)and a control group(ACEI/ARB group)according to different medication plans.Follow-up was conducted for 6 months to record changes in observation indicators and the occurrence of MACEs and adverse reactions in both groups,and to explore the influencing factors of adverse cardiovascular events in AMI patients.Results:1.A total of 120 AMI patients undergoing elective PCI were included in the study,with a mean age of 58.62±10.37 years,including 59 patients in the experimental group and 61 patients in the control group.There were no statistically significant differences in gender,age,smoking history,drinking history,hypertension history,and PCI-related data between the two groups(P>0.05).The incidence of hypertension in patients with three-vessel coronary artery disease was 50.7%,which was higher than that in patients with single or double-vessel coronary artery disease(P<0.05).The Gensini score of hypertensive patients with coronary artery disease was higher than that of non-hypertensive patients(45.90±16.09 vs.38.55±13.81),and the difference was statistically significant(P<0.05).Among patients with ST-segment elevation myocardial infarction,the proportion of smokers was 68.5%,which was significantly higher than that in patients without ST-segment elevation myocardial infarction(P<0.05).2.The results of sacubitril/valsartan medication showed that 15.3%of patients took a dose of 25mg,50.8%took a dose of 50-100mg,and 33.9%took a dose exceeding100mg.During the medication period,the dosage was adjusted according to the patient’s condition,and the results showed that 8.47%of patients had a reduced dosage,6.78%had an increased dosage,and 84.7%maintained the same dosage.None of the patients were titrated to the target dose.Correlation analysis between the last dose of medication and theΔLVEF classification of patients showed no significant correlation between the dose of medication and theΔLVEF classification(r=0.066,P>0.05).3.The results of the two groups of patients before and after treatment for heart function and cardiac remodeling showed that there was a difference in LVEF between the ARNI group before and after treatment(63.72±8.64 vs.64.20±8.49,P<0.05).There was no statistically significant difference in LVEF before and after treatment in the ACEI/ARB group(63.72±8.64 vs.64.20±8.49,P>0.05).There was no difference in LVEDD and LVESD before and after treatment in both groups(P>0.05).The NT-Pro BNP of both groups of patients decreased after treatment,and the difference was statistically significant(P<0.05).TheΔLVEF andΔNT-Pro BNP level changes in the ARNI group before and after treatment were significantly different from those in the ACEI/ARB group(P<0.05),and the efficacy of the ARNI group was better than that of the ACEI/ARB group.4.After 6 months of treatment in the ARNI group,the Ty G index of the patients decreased significantly compared to before treatment(9.07±0.62 vs.4.94±2.79),and the difference was statistically significant(P<0.05).Moreover,the Ty G index in the ARNI group after treatment was lower than that in the control group(4.94±2.79 vs.9.16±0.65),and the difference was statistically significant(P<0.05).5.There was no significant difference in baseline and 6-month UA,Scr,and K+levels between the two groups(P>0.05).There was no significant change in UA,Scr,and K~+levels before and after treatment in the ARNI group,while the UA,Scr,and K+levels in the ACEI/ARB group after 6 months of treatment showed an increasing trend compared to baseline,and the difference was statistically significant(P<0.05),but they were still within the normal range.6.The results of this study showed that there were 19 cases of MACEs,with an incidence rate of 15.8%.The incidence rate of the ARNI group was 11.86%,and the incidence rate of the ACEI/ARB group was 19.67%,with no significant difference between the two groups(P>0.05).The occurrence of MACEs in both groups was mainly angina,and no cases of cardiac death were observed.In terms of adverse reactions,there were a total of 8 cases of adverse reactions in both groups,with an incidence rate of 6.66%.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).The incidence of hypotension in the ARNI group was 3.39%,and no cases of dry cough were observed.The incidence of dry cough in the ACEI/ARB group was 9.84%,and no cases of hypotension were observed.7.Multivariate logistic regression analysis showed that the level of Lp(a)at admission was an independent risk factor for postoperative reduced ejection fraction heart failure(LVEF<50%)in patients undergoing elective PCI(OR=1.041,P<0.05).The MACEs regression analysis results showed that diabetes was an independent risk factor for MACEs in patients undergoing elective PCI(OR=3.312,P<0.05).Conclusion:1.Sacubitril/valsartan and ACEI/ARB can improve the cardiac function of patients with acute myocardial infarction undergoing elective PCI,prevent ventricular remodeling,and reduce NT-Pro BNP levels.2.Compared with ACEI/ARB,sacubitril/valsartan is more effective in improving cardiac function,preventing ventricular remodeling,reducing NT-Pro BNP levels,and reducing Ty G index.However,there is no significant correlation between the improvement of LVEF and the dose of sacubitril/valsartan.There is no significant difference in the incidence of MACEs and adverse reactions between the two drugs in the short term.3.The Lp(a)is an independent risk factor for postoperative heart failure in AMI patients,and early intervention measures should be taken to reduce the risk of heart failure.Diabetes is an independent risk factor for MACEs in AMI patients.For AMI patients with a history of diabetes,blood sugar should be controlled to reduce the incidence of MACEs and improve patient prognosis. |
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