沙库巴曲缬沙坦治疗急性心肌梗死后心力衰竭的效果

Efficacy of Sacubitril/Valsartan in the Patients with Heart Failure after Acute Myocardial Infarction

目的评估沙库巴曲缬沙坦治疗急性心肌梗死后心力衰竭的效果。方法回顾性纳入2018年6月至2019年6月郑州大学第一附属医院心内科因急性心肌梗死住院且出现射血分数降低的心衰(HFrEF)或射血分数中间范围型心衰(HFmrEF)的173例患者,根据用药情况分为ARNI组(55例)和ACEI/ARB组(118例)。主要观察指标为两组服药1 a后血浆氨基末端脑钠肽前体(NT-proBNP)水平、左室射血分数(LVEF)、左心室舒张末期内径(LVEDD),次要观察指标为因心衰再入院、心源性死亡及全因死亡发生率,安全性指标包括再发心肌梗死、症状性低血压、肾功能恶化、高钾血症、血管神经性水肿等。结果两组患者一般资料差异无统计学意义(P>0.05)。服药1 a时,ARNI组有29.1%(16/55)的患者LVEDD缩小≥10 mm,ACEI/ARB组为10.2%(12/118),差异有统计学意义(P<0.05)。ARNI组LVEF增高≥5%的患者占50.9%(28/55),ACEI/ARB组为33.9%(40/118),差异有统计学意义(P<0.05)。ARNI组中因心衰再入院的患者占30.9%(17/55),ACEI/ARB组为47.5%(56/118),差异有统计学意义(P<0.05)。ARNI组有2例患者死亡,ACEI/ARB组有3例死亡,两组死亡率差异无统计学意义(P>0.05)。两组患者再发心肌梗死、症状性低血压、高钾血症、血管神经性水肿及肾功能恶化者占比差异无统计学意义(P>0.05)。结论对于急性心肌梗死后HFrEF和HFmrEF的患者,在血流动力学稳定的情况下,应用沙库巴曲缬沙坦比ACEI/ARB在改善心室重构和减少因心衰再入院方面更有优势。

Objective To evaluate the efficacy of sacubitril/valsartan in the patients with heart failure after acute myocardial infarction.Methods A total of 173 hospitalized patients with heart failure with reduced ejection fraction(HFrEF)or heart failure with midrange ejection fraction(HFmrEF)after acute myocardial infarction in Department of Cardiology,the First Affiliated Hospital of Zhengzhou University from June 2018 to June 2019 were included in this retrospective analysis.According to the medication after hemodynamic stabilization,the patients were divided into ARNI group(55 cases)and ACEI/ARB group(118 cases).The primary effectiveness observation indexes were plasma NT-proBNP level,left ventricular ejection fraction(LVEF)and left ventricular end diastolic dimension(LVEDD)after taking the medicine for 1 year.The secondary observation indexes were hospitalization for heart failure,cardiac death and all-cause death.The safety indexes were recurrent myocardial infarction,symptomatic hypotension,deterioration of renal function,hyperkalemia,angioneurotic edema,etc.Results There was no statistical difference in general information between the two groups of patients(P>0.05).When taking the medicine for 1 year,percent of patients with≥10 mm LVEDD reduction was 29.1%(16/55)in ANRI group and 10.2%(12/118)in ACEI/ARB group(P<0.05).Prevalence of LVEF increased of≥5%was 50.9%(28/55)in ANRI group and 33.9%(40/118)in ACEI/ARB group(P<0.05).Rate of rehospitalization due to heart failure was 30.9%(17/55)in ARNI group and 47.5%(56/118)in ACEI/ARB group(P<0.05).There were 2 deaths in ARNI group and 3 deaths in ACEI group(P>0.05).There was no statistical difference in the incidence of recurrent myocardial infarction,symptomatic hypotension,hyperkalemia,angioneurotic edema,and deterioration of renal function between the two groups(P>0.05).Conclusion For patients with HFrEF or HFmrEF after acute myocardial infarction,the application of sacubitril/valsartan is more advantageous than ACEI/ARB in improving ventricular remodeling and re-admission due to heart failure under the condition of stable hemodynamics.