PMID- 38238027
OWN - NLM
STAT- MEDLINE
DCOM- 20240122
LR  - 20240131
IS  - 2053-3624 (Print)
IS  - 2053-3624 (Electronic)
IS  - 2053-3624 (Linking)
VI  - 11
IP  - 1
DP  - 2024 Jan 18
TI  - Use of sacubitril/valsartan early after CABG.
LID - 10.1136/openhrt-2023-002492 [doi]
LID - e002492
AB  - BACKGROUND: Heart failure (HF) remains a major public health problem with a high 
      mortality and morbidity worldwide. Currently, there is no optimal 
      revascularisation strategy for patients with ischaemic cardiomyopathy despite 
      suggestions that coronary artery bypass graft (CABG) may be superior to medical 
      therapy in improving survival. However, CABG may be associated with substantial 
      risk in HF subjects. We therefore aimed to evaluate the safety and efficacy of 
      the early initiation of sacubitril/valsartan in haemodynamically stabilised 
      patients with HF with reduced ejection fraction (HFrEF) after early CABG. 
      METHODS: This was an open-label study in which ~80 patients after CABG were 
      randomised either to the early or late initiation of the sacubitril-valsartan. 
      The study included patients >40 years with left ventricular ejection fraction 
      <45% and New York Heart Association (NYHA) class II-IV at the early stage after 
      CABG. Patients underwent intervention, the starting dose of sacubitril/valsartan 
      (24/26 mg or 49/51 mg two times per day). The follow-up took place every 4 weeks 
      except the first visit, which took place in 2 weeks after initiation. The primary 
      endpoint assessed the key safety outcomes, the secondary endpoints were: the 
      quality of life measured, the N-terminal pro-B-type natriuretic peptide 
      (NT-proBNP) changes and 6 min walk test (6MWT). RESULTS: In total, 83 patients 
      were screened and 77 patients were enrolled. The majority of patients (84.4%) 
      were in the NYHA class III at randomisation. The number of patients who 
      discontinued the study was low in both groups (2.5%, 5.2%), and renal function, 
      hyperkalaemia and symptomatic hypotension rarely seen in both groups did not 
      differ significantly. The improvement in quality of life and distance at the 6MWT 
      in both groups was significant (p<0.001). The NT-proBNP concentration decreased 
      in both groups, the significant reduction was in the early group (p<0.001) versus 
      the postdischarge group. CONCLUSIONS: The early initiation of 
      sacubitril/valsartan in patients after CABG with HFrEF is safe and effective. 
      Adverse events and permanent discontinuation were low. The NT-proBNP 
      concentration reduced significantly with the early in-hospital initiation.
CI  - (c) Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Nurzhanova, Madina
AU  - Nurzhanova M
AUID- ORCID: 0000-0003-2561-8707
AD  - Scientific Research Institute of Cardiology and Internal Diseases, Almaty, 
      Kazakhstan.
AD  - Kazakhstan Medical University 'Graduate School of Public Health', Almaty, 
      Kazakhstan.
FAU - Musagaliyeva, Aisulu
AU  - Musagaliyeva A
AD  - Scientific Research Institute of Cardiology and Internal Diseases, Almaty, 
      Kazakhstan.
FAU - Zhakypova, Raushan
AU  - Zhakypova R
AD  - Scientific Research Institute of Cardiology and Internal Diseases, Almaty, 
      Kazakhstan.
FAU - Senkibayeva, Daniya
AU  - Senkibayeva D
AD  - Scientific Research Institute of Cardiology and Internal Diseases, Almaty, 
      Kazakhstan.
FAU - Rakisheva, Amina
AU  - Rakisheva A
AUID- ORCID: 0000-0001-9842-962X
AD  - Scientific Research Institute of Cardiology and Internal Diseases, Almaty, 
      Kazakhstan amina.grakisheva@gmail.com.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20240118
PL  - England
TA  - Open Heart
JT  - Open heart
JID - 101631219
RN  - WB8FT61183 (sacubitril and valsartan sodium hydrate drug combination)
RN  - 17ERJ0MKGI (sacubitril)
RN  - 0 (Tetrazoles)
RN  - 80M03YXJ7I (Valsartan)
RN  - 0 (Aminobutyrates)
RN  - 0 (Biphenyl Compounds)
RN  - 0 (Drug Combinations)
SB  - IM
MH  - Humans
MH  - *Heart Failure/diagnosis/drug therapy
MH  - Stroke Volume
MH  - Quality of Life
MH  - Aftercare
MH  - Tetrazoles/adverse effects
MH  - Ventricular Function, Left
MH  - Patient Discharge
MH  - Valsartan/adverse effects
MH  - Coronary Artery Bypass/adverse effects
MH  - *Aminobutyrates
MH  - *Biphenyl Compounds
MH  - Drug Combinations
PMC - PMC10806467
OTO - NOTNLM
OT  - Coronary Artery Bypass
OT  - Coronary Artery Disease
OT  - Heart Failure
OT  - Pharmacology, Clinical
COIS- Competing interests: AR received a speaker honorarium from AstraZeneca, Novartis 
      and Roche.
EDAT- 2024/01/19 00:42
MHDA- 2024/01/22 06:41
PMCR- 2024/01/18
CRDT- 2024/01/18 21:13
PHST- 2023/09/25 00:00 [received]
PHST- 2024/01/03 00:00 [accepted]
PHST- 2024/01/22 06:41 [medline]
PHST- 2024/01/19 00:42 [pubmed]
PHST- 2024/01/18 21:13 [entrez]
PHST- 2024/01/18 00:00 [pmc-release]
AID - openhrt-2023-002492 [pii]
AID - 10.1136/openhrt-2023-002492 [doi]
PST - epublish
SO  - Open Heart. 2024 Jan 18;11(1):e002492. doi: 10.1136/openhrt-2023-002492.