沙库巴曲缬沙坦对比雷米普利对接受PCI治疗的AMI患者早期心室重构的影响:一项单中心倾向性匹配分析

Effect of sacubitril/valsartan versus ramipril on early myocardial remodeling in AMI patients undergoing PCI:a propensity matching analysis in a single center

目的:通过倾向性评分匹配法探讨沙库巴曲缬沙坦(Sacubitril/Valsartan,LCZ696)与雷米普利相比对急性心肌梗死(AMI)经皮冠状动脉治疗患者早期左室重构的影响。方法:回顾性收集2019年12月1日—2021年8月就诊泰达国际心血管病医院行经皮冠状动脉治疗的195例急性心肌梗死患者病例资料,根据出院用药分为沙库巴曲缬沙坦组(94例)和雷米普利组(101例),通过倾向性评分匹配减少药物选择偏差和混杂因素,比较两组治疗1月后心脏超声指标[左室舒张末直径(LVDd)、室间隔厚度(IVS)、左室后壁(LVPW)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、每搏量(SV)、左室射血分数(LVEF)]的变化。结果:匹配后,沙库巴曲缬沙坦组和雷米普利组各66例。治疗1个月后两组LVEDV[102.00(88.75,113.25)mL vs.94.00(82.75,110.50)mL,Z=-1.179,P=0.238]、LVESV[39.50(31.75,52.00)mL vs.37.00(29.75,46.00)mL,Z=-1.639,P=0.101]和LVEF[(58.77±7.66)%vs.(60.50±6.77)%,t=-1.373,P=0.172]差异均无统计学意义。两组LVEF均较治疗前升高,沙库巴曲缬沙坦组[58.00(49.00,62.25)%vs.59.00(53.75,64.25)%,Z=-3.460,P=0.001],雷米普利组[57.50(51.75,63.50)%vs.60.00(56.00,66.00)%,Z=-3.167,P=0.002]差异有统计学意义。结论:应用沙库巴曲缬沙坦和雷米普利治疗1个月后,两组患者LVEF均较治疗前改善。但在逆转心肌梗死后早期左室重构并未发现沙库巴曲缬沙坦优于雷米普利。

Objective:To investigate the effect of sacubatril/valsartan(LCZ696)versus ramipril on early left ventricular remodeling(LVR)in patients with acute myocardial infarction(AMI)undergoing percutaneous coronary intervention(PCI)by propensity score matching method(PSM).Methods:A retrospective analysis was done on 195 patients with AMI underwent PCI in TEDA International Cardiovascular Hospital from December 1,2019 to August 2021.According to the medication,there were 94 patients in LCZ696 group and 101 patients in ramipril group.PSM was performed to minimize the impact of selection bias for the medication and confounding factors.The echocardiographic parameters[left ventricular end-diastolic diameter(LVDd),ventricular septal thickness(IVS),left ventricular posterior wall(LVPW),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),stroke volume(SV)and left ventricular ejection fraction(LVEF)]were compared.Results:After matching,there were 66 patients in each group.After one month of treatment,no significant difference in LVEDV[102.00(88.75,113.25)mL vs.94.00(82.75,110.50)mL,Z=-1.179,P=0.238],LVESV[39.50(31.75,52.00)mL vs.37.00(29.75,46.00)mL,Z=-1.639,P=0.101],and LVEF[(58.77±7.66)%vs.(60.50±6.77)%,t=-1.373,P=0.172]were found between two groups.After treatment,LVEF significantly increased in both groups.There was significant difference between sacubatril/valsartan[58.00(49.00,62.25)%vs.59.00(53.75,64.25)%,Z=-3.460,P=0.001]and ramipril[57.50(51.75,63.50)%vs.60.00(56.00,66.00)%,Z=-3.167,P=0.002].Conclusion:In AMI patient undergoing PCI,one month after treatment with sacubitril/valsartan and ramipril,LVEF were improvedin both group,but sacubitril/valsartan did not have a significant reverse early remodeling effect compared with ramipril.