Physicians' Academy for Cardiovascular Education

ARNI may reduce total heart failure events in patients with acute MI

Impact of Sacubitril/Valsartan Versus Ramipril on Total Heart Failure Events in the PARADISE-MI trial

Literature - Pfeffer MA, Claggett B, Lewis EF et al., - Circulation 2021;144:00–00. DOI: 10.1161/CIRCULATIONAHA.121.057429

Introduction and methods


In the PARADISE MI trial, sacubitril/valsartan did not reduce the primary composite outcome of time to CV death of time to first heart failure event (hospitalization or outpatient) compared to ramipril in patients with acute myocardial infarction [1].

In this analysis, additional prespecified end points were explored, which could provide information on the effects of ARNI in high-risk patients after MI. More specifically, this analysis focused on total (first and recurrent) clinical end point committee (CEC)-adjudicated and investigator-reported events.

Study design

PARADISE-MI was a double-blind, active-controlled, randomized, clinical trial in which sacubitril/valsartan was compared with ramipril in 5661 patients with acute MI and either left ventricular ejection fraction ≤40% or transient pulmonary congestion. Patients with previous heart failure of clinical instability were excluded.


Investigator-reported time-to-first event and occurrence of recurrent events (hospitalizations for heart failure, outpatient heart failure, or CV death).

Main results


This exploratory analysis of PARADISE-MI suggest that recurrent HF events using both CEC adjudications and investigator reports are reduced by sacubitril/valsartan. The authors conclude that these findings provide supportive information for the already indicated replacement of an ACEi with sacubitril/valsartan once the development to symptomatic HF has occurred.


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Find this article online at Circulation

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