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Research Article: Safety and efficacy of sacubitril/valsartan vs. benazepril administered as initial treatment for STEMI patients with mid-range ejection fraction: a propensity score matching analysis

Date Published: 2026-05-28

Abstract:
We assessed the safety and efficacy of initial treatment with sacubitril/valsartan (S/V) in STEMI patients with mid-range left ventricular ejection fraction (LVEF, 40%–49%). We consecutively enrolled STEMI patients who received successful reperfusion therapy at the Second Hospital of Hebei Medical University between January 2019 and January 2025. Clinic follow-up visits were performed at 2 weeks and 1 month after treatment initiation. PSM was used to balance baseline characteristics between the benazepril and S/V cohorts, minimizing selection bias and confounding. Echocardiographic parameters were assessed at baseline (within 24?h of symptom onset) and at the 1-month follow-up. Major adverse cardiac events (MACE) and safety outcomes were systematically reported. A total of 134 eligible patients were enrolled, including 96 in the S/V cohort and 38 in the benazepril cohort. After 1:1 PSM, 35 patients were included in each matched group, with well-balanced baseline characteristics. After 1 month of treatment, the S/V group showed a significantly greater reduction in left ventricular end-systolic volume (LVESV), as well as greater improvements in left ventricular ejection fraction (LVEF) and left ventricular global longitudinal strain (GLS), compared with the benazepril group (all P <?0.05). There were no significant between-group differences in the incidence of major adverse cardiac events (MACE) or safety endpoints (all P >?0.05). In STEMI patients with mid-range LVEF, initial S/V and benazepril treatment had comparable safety profiles. S/V showed superior efficacy in improving short-term cardiac systolic function, as measured by surrogate echocardiographic endpoints. These preliminary findings require validation in larger, prospective randomized controlled trials with longer follow-up to confirm whether these benefits translate into improved long-term clinical outcomes.

Introduction:
ST-segment elevation myocardial infarction (STEMI), a life-threatening acute coronary syndrome, is characterized by acute cardiomyocyte necrosis caused by prolonged ischemia secondary to complete coronary artery occlusion ( 1 ). Despite timely and successful reperfusion therapy, up to 25% of STEMI patients develop subsequent heart failure (HF), which is strongly associated with increased mortality and poor long-term prognosis ( 2 , 3 ). HF with mid-range ejection fraction (HFmrEF), defined as left ventricular…

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