Angiotensin Receptor-Neprilysin Inhibitor in Acute Myocardial Infarction.

In patient with symptomatic heart failure sacubitril valsartan has been found to reduces the risk of hospitalization and death from cardiovascular causes more effectively then angiotensin converting enzymes inhibitor trail comparing the effect of these drugs in acute myocardial infarction is lacking.We randomly assigned patient with acute myocardial infarction complicated with reduced LVEF, or pulmonary congestion to recieve sacubitril 97mg-valsartan 103mg and ramipril 5mg twice daily the primary outcome was death from cardiovascular causes or incident heart failure, outpatient symptomatic heart failure or heart failure leading to hospitalization whichever occure first.Total 566 patient was taken in randomization 283 receive sacubitril-valsartan and 283 receive ramipril over a median of 22 months total outcome occure in 138 patient in sacubitril-valsartan group and in137 patient with ramipril group(hazard ratio 0.90: 95%confidence interval death from cardiovascular causes or hospitalization for heart failure occure i 10.9% patient reciveing sacubitril-valsartan and in 11.8%patient with ramipril group death from cardiovascular causes is 5.9 and 6.7% respectively death from anyother causes is 7.5 and 8.5 % respectively in both sacubitril-valsartan and ramipril group.Sacubitril-valsartan was not associated with significantly lower incidence of death from cardiovascular causes or incidents heart failure then ramipril in patients with acute myocardial infarction.