Outcomes of Sacubitril–Valsartan Versus ACEIs/ARBs Post-PCI in HFrEF Following AMI: Evidence from a Bangladeshi Perspective

Background: After an acute myocardial infarction (AMI), heart failure with reduced ejection fraction (HFrEF) is still a leading cause of morbidity and death, especially in environments with limited resources. This study compared post-PCI patients with AMI and HFrEF in a Bangladeshi population for clinical efficacy between Sacubitril-Valsartan and ACEI/ARB therapy. Methods: From July 2023 to June 2024, 80 AMI patients with LVEF <40% who had successful percutaneous coronary intervention (PCI) were enrolled in this prospective, comparative study at Bangabandhu Sheikh Mujib Medical University (BSMMU). Participants were split equally between two groups: ACEI/ARB (n = 40) and Sacubitril-Valsartan (n = 40). The baseline characteristics were similar. Patients were monitored for one and six months to evaluate changes in LVEF, NT-proBNP levels, cardiovascular mortality, heart failure-related hospitalisations, and treatment expenses. Results: The Sacubitril-Valsartan group demonstrated a more marked decrease in NT-proBNP levels (from 3550 ± 1150 to 1250 ± 580 pg/mL vs 3400 ± 1100 to 2150 ± 890 pg/mL, p = 0.001) and a significantly larger improvement in LVEF at the 6-month follow-up (mean change 8.6% ± 3.3 vs 4.4% ± 2.7, p = 0.001). The Sacubitril-Valsartan group had significantly lower rates of heart failure-related hospitalisations (7.5% vs. 20%, p = 0.03) and cardiovascular mortality (5% vs. 15%, p = 0.04). The cost of treatment, however, was higher (USD 1550 ± 210 vs 850 ± 160, p = 0.04). Conclusion: Despite higher treatment costs, sacubitril-valsartan significantly improved outcomes in post-PCI AMI patients with HFrEF by outperforming ACEI/ARB therapy.