Sacubitril-valsartan does not cut risk for death, heart failure after myocardial infarction

(HealthDay)—For patients with myocardial infarction, sacubitril-valsartan is not associated with a reduced incidence of death from cardiovascular causes or incident heart failure compared with ramipril, according to a study published in the Nov. 11 issue of the New England Journal of Medicine.

Marc A. Pfeffer, M.D., Ph.D., from Brigham and Women's Hospital in Boston, and colleagues randomly assigned patients with myocardial infarction complicated by a reduced left ventricular ejection fraction, pulmonary congestion, or both to receive sacubitril-valsartan or ramipril in addition to recommended therapy (2,830 and 2,831 patients, respectively).

The researchers found that a primary outcome event (death from cardiovascular causes or incident heart failure [outpatient symptomatic heart failure or heart failure leading to hospitalization]) occurred in 11.9 and 13.2 percent of patients in the sacubitril-valsartan and ramipril groups, respectively, during a median of 22 months (hazard ratio [HR], 0.90; 95 percent confidence interval [CI], 0.78 to 1.04; P = 0.17). Death from cardiovascular causes or hospitalization for heart failure occurred in 10.9 and 11.8 percent of patients in the sacubitril-valsartan and ramipril groups, respectively (HR, 0.91; 95 percent CI, 0.78 to 1.07), while death from cardiovascular causes occurred in 5.9 and 6.7 percent, respectively (HR, 0.87; 95 percent CI, 0.71 to 1.08) and death from any cause occurred in 7.5 and 8.5 percent, respectively (HR, 0.88; 95 percent CI, 0.73 to 1.05).

"There was no significant benefit of sacubitril-valsartan with respect to the primary outcome," the authors write.

Several authors disclosed financial ties to pharmaceutical and health care companies, including Novartis, which manufactures sacubitril-valsartan and funded the study.

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