{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:28:52Z","timestamp":1788168532038,"version":"build-2803163510"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2022,12,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>In patients who survive an acute myocardial infarction (AMI), angiotensin-converting enzyme inhibitors decrease the risk of subsequent major cardiovascular events. Whether angiotensin-receptor blockade and neprilysin inhibition with sacubitril\/valsartan reduce major coronary events more effectively than angiotensin-converting enzyme inhibitors in high-risk patients with recent AMI remains unknown. We aimed to compare the effects of sacubitril\/valsartan on coronary outcomes in patients with AMI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a prespecified analysis of the PARADISE-MI trial (Prospective ARNI vs ACE Inhibitors Trial to Determine Superiority in Reducing Heart Failure Events After MI), which compared sacubitril\/valsartan (97\/103 mg twice daily) with ramipril (5 mg twice daily) for reducing heart failure events after myocardial infarction in 5661 patients with AMI complicated by left ventricular systolic dysfunction, pulmonary congestion, or both. In the present analysis, the prespecified composite coronary outcome was the first occurrence of death from coronary heart disease, nonfatal myocardial infarction, hospitalization for angina, or postrandomization coronary revascularization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Patients were randomly assigned at a median of 4.4 [3.0\u20135.8] days after index AMI (ST-segment\u2013elevation myocardial infarction 76%, non\u2013ST-segment\u2013elevation myocardial infarction 24%), by which time 89% of patients had undergone coronary reperfusion. Compared with ramipril, sacubitril\/valsartan decreased the risk of coronary outcomes (hazard ratio, 0.86 [95% CI, 0.74\u20130.99],\n                      <jats:italic>P<\/jats:italic>\n                      =0.04) over a median follow-up of 22 months. Rates of the components of the composite outcomes were lower in patients on sacubitril\/valsartan but were not individually significantly different.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In survivors of an AMI with left ventricular systolic dysfunction and pulmonary congestion, sacubitril\/valsartan\u2014compared with ramipril\u2014reduced the risk of a prespecified major coronary composite outcome. Dedicated studies are necessary to confirm this finding and elucidate its mechanism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT02924727.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.122.060841","type":"journal-article","created":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T05:00:31Z","timestamp":1667365231000},"page":"1749-1757","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":31,"title":["The Effects of Angiotensin Receptor-Neprilysin Inhibition on Major Coronary Events in Patients With Acute Myocardial Infarction: Insights From the PARADISE-MI Trial"],"prefix":"10.1161","volume":"146","clinical-trial-number":[{"clinical-trial-number":"nct02924727","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5546-262X","authenticated-orcid":true,"given":"Roxana","family":"Mehran","sequence":"first","affiliation":[{"name":"The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6896-2941","authenticated-orcid":true,"given":"Philippe Gabriel","family":"Steg","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Cit\u00e9, AP-HP (Assistance Publique-H\u00f4pitaux de Paris), FACT (French Alliance for Cardiovascular Trials) and INSERM U-1148, France (P.G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3876-7568","authenticated-orcid":true,"given":"Marc A.","family":"Pfeffer","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (M.A.P., K.J., B.C., S.D.S., E.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5243-1959","authenticated-orcid":true,"given":"Karola","family":"Jering","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (M.A.P., K.J., B.C., S.D.S., E.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4215-9218","authenticated-orcid":true,"given":"Brian","family":"Claggett","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (M.A.P., K.J., B.C., S.D.S., E.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eldrin F.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA (E.F.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0045-3291","authenticated-orcid":true,"given":"Christopher","family":"Granger","sequence":"additional","affiliation":[{"name":"Duke University Medical Center, Durham, NC (C.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6635-1466","authenticated-orcid":true,"given":"Lars","family":"K\u00f8ber","sequence":"additional","affiliation":[{"name":"Professor of Cardiology, Department of Clinical Medicine, University of Copenhagen, Denmark (L.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2764-6779","authenticated-orcid":true,"given":"Aldo","family":"Maggioni","sequence":"additional","affiliation":[{"name":"ANMCO Research Center, Heart Care Foundation, Florence, Italy (A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2516-0145","authenticated-orcid":true,"given":"Douglas L.","family":"Mann","sequence":"additional","affiliation":[{"name":"Washington University Medical Center, St Louis, MO (D.L.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6317-3975","authenticated-orcid":true,"given":"John J.V.","family":"McMurray","sequence":"additional","affiliation":[{"name":"British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Scotland (J.J.V.M., M.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Lucien","family":"Rouleau","sequence":"additional","affiliation":[{"name":"Montr\u00e9al Heart Institute, University of Montr\u00e9al, Quebec, Canada (J.-L.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3698-9597","authenticated-orcid":true,"given":"Scott D.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA (M.A.P., K.J., B.C., S.D.S., E.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Ducrocq","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, H\u00f4pital Bichat Assistance Publique H\u00f4pitaux de Paris. 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