Berwanger, O. et al. (2022) Sacubitril/valsartan versus ramipril for patients with acute myocardial infarction: win‐ratio analysis of the PARADISE‐MI trial. European Journal of Heart Failure, 24(10), pp. 1918-1927. (doi: 10.1002/ejhf.2663) (PMID:36054480)
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Abstract
Background: The win ratio can incorporate different types of outcomes and enhance statistical power, making it a useful method for analyzing composite outcomes in cardiovascular trials. The application of this approach to the PARADISE-MI trial provides an additional perspective into understanding the effects of sacubitril/valsartan in patients with acute myocardial infarction. Methods: We conducted a post-hoc analysis of the PARADISE-MI trial, which randomly assigned patients with acute myocardial infarction complicated by a reduced left ventricular ejection fraction, pulmonary congestion, or both to receive either sacubitril/valsartan (97 mg of sacubitril and 103 mg of valsartan twice daily) or ramipril (5 mg twice daily) in addition to guideline-recommended therapy. The principal composite outcome was analyzed in the hierarchical order of death due to cardiovascular causes, first hospitalization for heart failure, and first outpatient episode of symptomatic heart failure. We included events confirmed by the clinical event classification (CEC) committee as well as events identified by investigators that did not meet study definitions. Results were analyzed by the unmatched win ratio method. A win ratio that exceeds 1.00 reflects a better outcome. Results: A total of 5661 patients underwent randomization; 2830 were assigned to receive sacubitril-valsartan and 2831 to receive ramipril. The hierarchical analysis of the principal composite outcome demonstrated a larger number of wins [1,265,767 (15.7%)] than losses [1,079,502 (13.4%)] in the sacubitril/valsartan group (win ratio of 1.17, 95% confidence interval [CI],1.03 to 1.33; P=0.015). Sensitivity analyses using alternative definitions of the composite outcome showed results similar to those of the principal analysis, except for analysis restricted to events that met CEC definitions (win ratio of 1.11, 95% CI, 0.96 to 1.30; P=0.16). Conclusion: In this post-hoc analysis of the PARADISE-MI trial using the win ratio and including investigator-identified events not having CEC confirmation, sacubitril/valsartan was superior to ramipril among high-risk survivors of acute myocardial infarction.
| Item Type: | Articles |
|---|---|
| Additional Information: | Funded by Novartis. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | McMurray, Professor John |
| Authors: | Berwanger, O., Pfeffer, M., Claggett, B., Jering, K. S., Maggioni, A. P., Steg, P. G., Mehran, R., Lewis, E. F., Zhou, Y., van der Meer, P., De Pasquale, C., Merkely, B., Filippatos, G., McMurray, J. J.V., Granger, C. B., Solomon, S. D., and Braunwald, E. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
| Journal Name: | European Journal of Heart Failure |
| Publisher: | Wiley |
| ISSN: | 1388-9842 |
| ISSN (Online): | 1879-0844 |
| Published Online: | 29 August 2022 |
| Copyright Holders: | Copyright © 2022 European Society of Cardiology |
| First Published: | First published in European Journal of Heart Failure 24(10): 1918-1927 |
| Publisher Policy: | Reproduced in accordance with the publisher copyright policy |
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