Impact of Sacubitril/Valsartan (ARNI) Compared with ACEI/ARB in Patients with Acute Myocardial Infarction on Post-Infarction Left Ventricular Systolic Dysfunction: A Retrospective Analysis

Background: /Objectives: Angiotensin receptor-neprilysin inhibitor (AR-NI) has a well-established advantage over angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) therapy in patients (pts) with heart failure with reduced ejection fraction (HFrEF), but in pts after acute myocardial infarction (AMI) with left ventricular (LV) systolic dysfunction the advantage of ARNI has not been clearly proven. To com-pare of the efficacy of ARNI versus ACEI/ARB therapy in patients with the first AMI in terms of improvement of post-infarction LV systolic function. Methods: Overall 1473 pts (990M, median age 71 [64;77]) with AMI (the first AMI, complete coronary revascularization, no prior: coronary revas-cularization, history of HF) hospitalized in 2022-2024 were enrolled into retrospective cross-sectional analysis. The study population was catego-rized into pts receiving ARNI and ACEI/ARB. Then based on ARNI subgroup included age, sex, and LV ejection fraction (LVEF) matching was performed by using the 1:1 nearest neighbour method without returning. Finally two groups (ARNI vs ACEI/ARB) of 30 pts were obtained and an-alysed at baseline and in 6-week follow-up. The improvement of post-infarction LV systolic function was obtained as LVEF value, ΔLVEF and relative ΔLVEF (ΔLVEF / baseline LVEF). Results: The comparison of baseline characteristics revealed borderline lower initial LVEF (30 vs 36%, p=0.076) and higher frequency of of SGLT-2 inhibitors use (70% vs 36.7%, p=0.01) in the ARNI subgroup. In 6-week follow-up in both subgroups a significant improvement in the median LVEF values was achieved: from median LVEF value 30% (27.3; 38) up to 37% (30; 43; p=0.0008) in ARNI and from median LVEF value 36% (33; 39) up to 45% (42; 52; p<0.0001) in ACEI/ARB subgroup. Median ΔLVEF in the ACEI/ARB subgroup was higher [10% (6; 12)] than in the ARNI subgroup [6% (2; 10.25), p=0.018]. Similarly median relative ΔLVEF was higher in the ACEI/ARB subgroup [30% (15.4; 40)] than in the ARNI group [17.5% (7; 31.9), p=0.047]. Conclusions: Our current experience in ARNI therapy after AMI is promising, however, it is limited to a small group of patients with severe impairment of LV systolic function. Regardless of significant improvement of baseline LVEF observed in patients receiving both ACEI/ARB and ARNI in 6 week follow-up the value of absolute and relative LVEF increase were higher in subjects treated with ACEI/ARB. The clinical efficacy of early use of ARNI in the setting of AMI needs further evaluation.