Abstract
Heart failure is a possible complication following ST-elevation myocardial infarction (STEMI) even after revascularization. Neuroendocrine activation in the process of ventricular remodeling can be regulated by angiotensin receptor-neprilysin inhibitor (ARNI) as well as angiotensin-converting enzyme (ACE) inhibitor. The use of ARNI in heart failure with reduced ejection fraction has been found to be superior to ACE inhibitor. The role of ARNI on cardiac function in STEMI has not been established. A clinician treating a patient with STEMI considered giving sacubitril/valsartan to reduce the risk of developing heart failure. Literature search was performed in three electronic databases: PubMed, Embase, and Cochrane. Keywords in the form of text words and MeSH terms were arranged using Boolean operator technique. Critical appraisal of selected articles was carried out according to the guideline from Oxford Centre for Evidence-Based Medicine. Four relevant randomized clinical trials were obtained. There was a reduced risk of heart failure events at 6 months following STEMI who underwent percutaneous coronary intervention (PCI) in the sacubitril/valsartan group compared to ACE inhibitor group, with a relative risk (RR) of 0.35 (95%CI 0.15 – 0.84; p=0.037); RR 0.5 (95%CI 0.31 – 0.82; p=0.004); and number needed to treat (NNT) of 6. Similar results were also found in STEMI patients complicated by cardiogenic shock: RR 0.47 (95%CI 0.24 – 0.94; p=0.044). Sacubitril/valsartan is more effective than ACE inhibitor in reducing the risk of heart failure at 6 months following STEMI post-PCI.
Bahasa Abstract
Gagal jantung merupakan kemungkinan komplikasi pasca infark miokard akut dengan elevasi segmen ST (STEMI) bahkan setelah revaskularisasi. Aktivasi neuroendokrin dalam proses remodeling ventrikel dapat diregulasi dengan angiotensin receptor-neprilysin inhibitor (ARNI) maupun angiotensin-converting enzyme (ACE) inhibitor. Penggunaan ARNI dalam bentuk sacubitril/valsartan pada gagal jantung fraksi ejeksi menurun diketahui lebih superior dari ACE inhibitor. Peran ARNI terhadap fungsi jantung pada STEMI belum ditetapkan. Seorang klinisi yang merawat pasien STEMI mempertimbangkan pemberian sacubitril/valsartan untuk mengurangi risiko gagal jantung pasien tersebut. Penelusuran literatur dilakukan di tiga database elektronik: PubMed, Embase, dan Cochrane. Kata kunci berupa text word dan terminologi MeSH disusun dengan teknik Boolean operator. Telaah kritis pada artikel terseleksi dilakukan berdasarkan pedoman dari Oxford Centre for Evidence-Based Medicine. Didapatkan empat uji klinis acak tersamar yang relevan. Hasil telaah pada empat artikel tersebut menunjukkan adanya penurunan risiko kejadian gagal jantung 6 bulan pasca STEMI post-percutaneous coronary intervention (PCI) pada kelompok sacubitril/valsartan dibandingkan dengan ACE inhibitor dengan risiko relatif (RR) 0,35 (IK95% 0,15 – 0,84; p=0,037); RR 0,5 (IK95% 0,31 – 0,82; p=0,004); dan number needed to treat (NNT) 6. Hasil serupa juga ditemukan pada pasien STEMI dengan komplikasi syok kardiogenik: RR 0,47 (IK95% 0,24 – 0,94; p=0,044). Sacubitril/valsartan lebih efektif dibandingkan ACE inhibitor dalam menurunkan risiko gagal jantung 6 bulan pada pasien STEMI yang menjalani PCI.
Kata Kunci: ACE inhibitor, ARNI, gagal jantung, sacubitril/valsartan, STEMI
Recommended Citation
Andre, Nobian; Adila, Lana; Rizka, Aulia; and Rusdi, Lusiani
(2023)
"Efektivitas Sacubitril/Valsartan dalam Mencegah Gagal Jantung pada STEMI Pasca Percutaneous Coronary Intervention,"
Jurnal Penyakit Dalam Indonesia: Vol. 10:
Iss.
4, Article 8.
DOI: 10.7454/jpdi.v10i4.1435
Available at:
https://scholarhub.ui.ac.id/jpdi/vol10/iss4/8