The Effects of Sacubitril-Valsartan vs Enalapril on Left Ventricular Remodeling in ST-elevation Myocardial Infarction (PERI-STEMI)
STEMI
About this trial
This is an interventional treatment trial for STEMI focused on measuring ST-elevation myocardial infarction (STEMI), cardiovascular magnetic resonance (CMR), angiotensin receptor neprilysin inhibitor (ARNI), angiotensin-converting enzyme inhibitor (ACEI)
Eligibility Criteria
Inclusion Criteria:
- Aged between 18 - 75 years old
- First-time ST-segment elevation myocardial infarction based on the newest ESC guidelines
- Timely primary percutaneous coronary intervention within 12 hours from onset
- Written informed consent acquired
Exclusion Criteria:
- Known history of or persistent clinical chronic heart failure prior to randomization
- Previous use of ARNI, or intolerance or contraindications to study drugs including ARNI or ACEI
- History of significant chronic coronary obstruction and adverse ventricular remodeling
- History of any cardiomyopathy, valvular heart disease, congenital heart disease, stent or CABG, or planned open-heart surgery within 3 months
- History of hepatic impairment or history of cirrhosis with evidence of portal hypertension
- History of chronic renal dysfunction, or eGFR < 30 ml/min/1.73 m2
- History of malignancy and with a life span less than one year
- Patients with a known history of angioedema related to previous ACEIs/ARB therapy.
- With contraindication to MRI examination (pacemaker and claustrophobia) or cannot finish breath-holding when lying on the examination bed
- Pregnancy or nursing women
Sites / Locations
- West China Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
ARNI-Sacubitril-Valsartan
ACEI-Enalapril
patients randomized to angiotensin receptor neprilysin inhibitor (ARNI) group will receive 2 doses of angiotensin receptor blocker (ARB) to ensure a minimum 36-hour washout period prior to initiation of ARNI therapy, and then be started with the first dose or sacubitril-valsartan.
patients randomized to angiotensin-converting enzyme inhibitor (ACEI) group will directly start with the first dose of enalapril