Angiotensin Receptor–Neprilysin Inhibition in Acute Myocardial Infarction

This phase 3 randomized, double-blind trial PARADISE-MI compared sacubitril–valsartan to ramipril in patients with acute myocardial infarction, reduced left ventricular ejection fraction, pulmonary congestion, or both. Over a median follow-up of 22 months, the primary outcome (cardiovascular death or incident heart failure) occurred in 11.9% of sacubitril–valsartan recipients and 13.2% of ramipril recipients (HR 0.90; 95% CI, 0.78–1.04; P=0.17). Although numerical trends favored sacubitril–valsartan, differences were not statistically significant. Discontinuation due to adverse events occurred in 12.6% (sacubitril–valsartan) vs. 13.4% (ramipril). Hypotension was more common with sacubitril–valsartan, whereas cough was more frequent with ramipril. No major safety concerns were observed. The findings indicate that sacubitril–valsartan did not significantly outperform ramipril in preventing cardiovascular death or heart failure post–myocardial infarction.

This phase 3 randomized, double-blind trial PARADISE-MI compared sacubitril–valsartan to ramipril in patients with acute myocardial infarction, reduced left ventricular ejection fraction, pulmonary congestion, or both. Over a median follow-up of 22 months, the primary outcome (cardiovascular death or incident heart failure) occurred in 11.9% of sacubitril–valsartan recipients and 13.2% of ramipril recipients (HR 0.90; 95% CI, 0.78–1.04; P=0.17). Although numerical trends favored sacubitril–valsartan, differences were not statistically significant. Discontinuation due to adverse events occurred in 12.6% (sacubitril–valsartan) vs. 13.4% (ramipril). Hypotension was more common with sacubitril–valsartan, whereas cough was more frequent with ramipril. No major safety concerns were observed. The findings indicate that sacubitril–valsartan did not significantly outperform ramipril in preventing cardiovascular death or heart failure post–myocardial infarction.