急性ST段抬高型心肌梗死后左室收缩功能障碍患者早期应用沙库巴曲缬沙坦有效性及安全性研究

Efficacy and safety of sacubitril/valsartan in patients with left ventricular systolic dysfunction following acute ST segment elevation myocardial infarction

目的探讨急性ST段抬高型心肌梗死(STEMI)后左室收缩功能障碍(LVSD)患者早期应用沙库巴曲缬沙坦(诺欣妥)的有效性及安全性。方法本研究为单中心、前瞻性队列研究。连续性入选自2019年5月至2020年8月大连医科大学附属第一医院心内科收治的新发STEMI并成功行血运重建术后心脏超声示左室射血分数(LVEF)<45%的63例患者为研究对象。根据用药情况将其分为诺欣妥组(n=29)与血管紧张素转换酶抑制剂或血管紧张素受体抑制剂(ACEI/ARB)组(n=34)。比较两组患者的基线临床资料、随访资料、终点事件及不良事件的发生情况。应用超声心动图参数和血浆生化指标的变化来评估诺欣妥对左室重构的影响。结果两组患者的年龄、男性比例、生命体征、既往史、生化检验、左室功能及大小、罪犯血管、是否完全血运重建、出院时用药情况等比较,差异均无统计学意义(P>0.05)。随访6个月时,诺欣妥组LVEF高于ACEI/ARB组,差异有统计学意义(P<0.05);诺欣妥组左室舒张末期内径基线到6个月的变化值低于ACEI/ARB组,LVEF基线到6个月的变化值以及LVEF恢复至50%以上的患者比例明显高于ACEI/ARB组,差异有统计学意义(P<0.05)。两组的B型利钠肽及B型利钠肽基线到6个月的变化值比较,差异无统计学意义(P>0.05)。两组患者的心力衰竭住院、主要心脏不良事件、肾功能恶化、高钾血症、症状性低血压及血管神经性水肿的发生率比较,差异均无统计学意义(P>0.05)。结论急性STEMI后LVSD患者早期应用诺欣妥在改善收缩功能和减轻不良心室重构方面显著优于ACEI/ARB,且安全性良好。

Objective To investigate the efficacy and safety of sacubitril and valsartan(sacubitril/valsartan)in early treatment of left ventricular systolic dysfunction(LVSD)after acute ST-segment elevation myocardial infarction(STEMI).Methods This was a single center,prospective cohort study.From May 2019 to August 2020,63 patients with newly diagnosed STEMI and successful revascularization after cardiac ultrasound showed left ventricular ejection fraction(LVEF)<45%were consecutively enrolled in this study.They were divided into sacubitril/valsartan group(n=29)and angiotensin converting enzyme inhibitor or angiotensin receptor blockers(ACEI/ARB)group(n=34).Baseline clinical data,follow-up data,end-point events and adverse events were compared between the two groups.The changes of echocardiographic parameters and plasma biochemical parameters were used to evaluate the effect of sacubitril/valsartan on left ventricular remodeling.Results There were no significant differences in age,male proportion,vital signs,past history,biochemical test,left ventricular function and size,offender vessels,complete revascularization,and medication at discharge between the two groups(P>0.05).At 6 months of follow-up,the LVEF of sacubitril/valsartan group was higher than that of ACEI/ARB group,and the difference was statistically significant(P<0.05).The change value of left ventricular end-diastolic diameter from baseline to 6 months in the sacubitril/valsartan group was lower than that in the ACEI/ARB group,the change value of LVEF from baseline to 6 months and the proportion of patients with LVEF recovering to more than 50%were significantly higher than those in the ACEI/ARB group,and the differences were statistically significant(P<0.05).There was no significant difference in the change value of B-type natriuretic peptide and B-type natriuretic peptide from baseline to 6 months between the two groups(P>0.05).There were no significant differences in the incidence of heart failure hospitalization,major adverse cardiac events,renal function deterioration,hyperkalemia,symptomatic hypotension and angioneurotic edema between the two groups(P>0.05).Conclusion Early application of sacubitril/valsartan in LVSD patients after acute STEMI is significantly better than ACEI/ARB in improving systolic function and alleviating adverse ventricular remodeling,with good safety.