ArticleFrontiers in cardiovascular medicine2026
Early in-hospital initiation of angiotensin-receptor-neprilysin inhibitor in post-acute myocardial infarction patients with impaired left ventricular systolic function: a systematic review and meta-analysis of randomized controlled trials.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Aims: Heart failure (HF) is a common and serious complication following acute myocardial infarction (AMI), particularly in patients with impaired left ventricular systolic function [left ventricular ejection fraction (LVEF) < 50%] during hospitalization. Although angiotensin-receptor-neprilysin inhibitor (ARNI) therapy has proven benefit in chronic HF, evidence supporting its initiation during the index AMI admission remains limited. This study systematically evaluated the effects of early in-hospital initiation of ARNI therapy compared with angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy on cardiovascular outcomes in post- AMI patients with impaired systolic function. Methods: This systematic review and meta-analysis was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD420251007504). A comprehensive search was completed on 30 August 2025. We included randomized controlled trials (RCTs) enrolling hospitalized AMI patients with impaired systolic function (LVEF <50%) who initiated ARNI therapy during the index admission. The primary outcome was major adverse cardiovascular events (MACEs), defined as HF hospitalization, all-cause mortality, or recurrent acute coronary syndrome. Secondary outcomes included incidence of ventricular arrhythmia, cardiovascular death, stroke, changes in left-ventricular ejection fraction, NT-proBNP levels, and adverse events (AEs). Prespecified subgroup analyses and meta-regression were performed. Results: Twelve RCTs comprising 7,539 patients (ARNI: Conclusions: Among hospitalized post-AMI patients with impaired left ventricular systolic function, early in-hospital initiation of ARNI reduces MACEs, lowers the incidence of ventricular arrhythmia, and improves ventricular function compared with ACEI/ARB therapy, although careful monitoring for hypotension is required. These findings support early in-hospital ARNI adoption in this high-risk population and underscore the need for longer-term outcome studies.
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