Effect of angiotensin receptor neprilysin inhibitors in patients with STEMI: a systematic review and meta-analysis

Authors

Aymen Ahmed, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Muhammad Umer Sohail, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Muhammad Saad, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Zara Naveed, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Muhammad Sameer Arshad, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Areesha Jawed, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Adeena Musheer, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Anousheh Awais Paracha, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Ahmed Kamal Siddiqi, Division of Cardiothoracic Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.
Neha Saleem Paryani, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Izza Shahid, Division of Preventive Cardiology, Houston Methodist Academic Institute, Houston, TX, USA.
Muhammad Mustafa Memon, Rochester Regional HealthFollow

Department

Internal Medicine

Document Type

Article

Publication Title

Future Cardiology

Abstract

Background: ST-segment elevation myocardial infarction (STEMI) is responsible for high morbidity and mortality rates globally. Although the use of angiotensin-converting enzyme inhibitors (ACEIs) remains the cornerstone treatment for patients with STEMI, the use of angiotensin-receptor neprilysin inhibitors (ARNIs) may offer better outcomes than ACEIs. This meta-analysis compares the efficacy and safety of ARNIs versus ACEIs in patients with STEMI.

Methods: Randomized controlled trials (RCTs) were pooled from PubMed and Cochrane databases. A random-effects model calculated risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs).

Results: Five trials (n = 4,915) were included. ARNIs significantly reduced major adverse cardiovascular events (MACE) (RR: 0.66, 95% CI [0.50, 0.86]; p = 0.002) and hospitalizations for heart failure (HHF) (RR: 0.67, 95% CI [0.49, 0.92]; p = 0.01). ARNIs also improved left ventricular ejection fraction (LVEF) (WMD: 2.60, 95% CI[1.53, 3.68]; p < 0.00001) and lowered NT-proBNP levels (WMD: -268.89, 95% CI[-422.35, -115.42]; p = 0.0006). No significant differences were observed in recurrent myocardial infarction, cardiovascular death, or safety outcomes - except for hypotension, which was significantly more common with ARNI use.

Conclusions: ARNI therapy reduces MACE, HHF, and NT-proBNP levels and improves LVEF in patients with STEMI without increasing safety risks, except for hypotension. Further RCTs are needed to confirm these findings.

First Page

599

Last Page

609

DOI

10.1080/14796678.2025.2506350

Volume

21

Issue

8

Publication Date

6-1-2025

Medical Subject Headings

Humans; Angiotensin Receptor Antagonists (therapeutic use); Angiotensin-Converting Enzyme Inhibitors (therapeutic use); Neprilysin (antagonists & inhibitors); Randomized Controlled Trials as Topic; ST Elevation Myocardial Infarction (drug therapy); Stroke Volume; Treatment Outcome

PubMed ID

40418165

Recommended Citation

Ahmed, A., Sohail, M. U., Saad, M., Naveed, Z., Arshad, M. S., Jawed, A., Musheer, A., Paracha, A. A., Siddiqi, A. K., Paryani, N. S., Shahid, I., & Memon, M. M. (2025). Effect of angiotensin receptor neprilysin inhibitors in patients with STEMI: a systematic review and meta-analysis. Future Cardiology, 21 (8), 599-609. https://doi.org/10.1080/14796678.2025.2506350