Objective  To systematically review the efficacy and safety of dapagliflozin combined with sacubitril valsartan in the treatment of heart failure after acute myocardial infarction.

Methods  PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on dapagliflozin combined with sacubitril valsartan (combination treatment group) vs. sacubitril valsartan (monotherapy group) for the treatment of heart failure after acute myocardial infarction from inception to June 18, 2024. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was performed using RevMan 5.4 software.

Results  A total of 11 RCTs involving 1 060 patients were included. Meta-analysis results showed that compared with the monotherapy group, the efficiency of clinical treatment (OR=5.08, 95%CI 2.81 to 9.16, P<0.001), left ventricular ejection fraction (MD=5.02, 95%CI 4.08 to 5.95, P<0.001), 6-minute walking distance (MD=56.45, 95%CI 32.83 to 80.07, P<0.001) significantly increased in the combination treatment group, and the levels of N-terminal brain natriuretic peptide precursor (MD=-249.28, 95%CI -414.78 to -83.78, P=0.003) and the incidence of major adverse cardiovascular events (OR=0.24, 95%CI 0.15 to 0.41, P<0.001) significantly decreased in the combination treatment group. However, there was no statistically significant difference between the two groups in terms of reducing the incidence of adverse effects (OR=0.66, 95%CI 0.31 to 1.38, P=0.27).

Conclusion  Current evidence shows that the use of the combination of dapagliflozin and sacubitril valsartan for heart failure after acute myocardial infarction is more effective clinically and does not increase the incidence of adverse drug reactions compared with the treatment of sacubitril valsartan alone. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.

1.Chen Q, Su L, Liu C, et al. PRKAR1A and SDCBP serve as potential predictors of heart failure following acute myocardial infarction[J]. Front Immunol, 2022, 13: 878876. DOI: 10.3389/fimmu.2022.878876.

2.Li J, Dharmarajan K, Bai X, et al. Thirty-day hospital readmission after acute myocardial infarction in China[J]. Circ Cardiovasc Qual Outcomes, 2019, 12(5): e005628. DOI: 10.1161/CIRCOUTCOMES.119.005628.

3.Martens P, Nuyens D, Rivero-Ayerza M, et al. Sacubitril/valsartan reduces ventricular arrhythmias in parallel with left ventricular reverse remodeling in heart failure with reduced ejection fraction[J]. Clin Res Cardiol, 2019, 108(10): 1074-1082. DOI: 10.1007/s00392-019-01440-y.

4.Chan J, Siddiqui A. Pharmacological treatment of heart failure: recent advances[J]. Curr Cardiol Rev, 2024, 20(2): 29-38. DOI: 10.2174/011573403X270178231228061314.

5.McMurray JJ, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure[J]. N Engl J Med, 2014, 371(11): 993-1004. DOI: 10.1056/NEJMoa1409077.

6.Velazquez EJ, Morrow DA, DeVore AD, et al. Angiotensin-neprilysin inhibition in acute decompensated heart failure[J]. N Engl J Med, 2019, 380(6): 539-548. DOI: 10.1056/NEJMoa1812851.

7.Mao L, Cai D, Chi B, et al. Dapagliflozin reduces risk of heart failure rehospitalization in diabetic acute myocardial infarction patients: a propensity score-matched analysis[J]. Eur J Clin Pharmacol, 2023, 79(7): 915-926. DOI: 10.1007/s00228-023-03495-3.

8.曾宪涛, 包翠萍, 曹世义, 等. Meta分析系列之三:随机对照试验的质量评价工具[J].中国循证心血管医学杂志, 2012, 4(3): 183-185. [Zeng XT, Bao CP, Cao SY, et al. Meta-analysis series Ⅲ: quality assessment tools for randomized controlled trials[J]. Chinese Journal of Evidence-Bases Cardiovascular Medicine, 2012, 4(3): 183-185.] DOI: 10.3969/j.issn.1674-4055.2012.03.003.

9.Liang Z, Yang Y, Wang F, et al. Assessing the early prognosis of heart failure after acute myocardial infarction using left ventricular pressure-strain loop: a prospective randomized controlled clinical study[J]. Quant Imaging Med Surg, 2024, 14(2): 1957-1970. DOI: 10.21037/qims-23-1079.

10.苏鹏, 杨秀丽. 达格列净联合诺欣妥对非糖尿病急性心肌梗死患者急诊PCI术后心力衰竭的疗效观察 [J]. 中国循证心血管医学杂志, 2023, 15(8): 970-973.[Su P, Yang XL. Effect of dapagliflozin combined with entresto in the treatment of heart failure after emergency interventional therapy in non-diabetic acute myocardial infarction patients[J]. Chinese Journal of Evidence-Bases Cardiovascular Medicine, 2023, 15(8): 970-973.] DOI: 10.3969/j.issn.1674-4055.2023.08.17.

11.郑杰. 急性心肌梗死患者急诊介入治疗后达格列净联合诺欣妥对心力衰竭的影响[J]. 养生保健指南, 2024, (3): 118-120. [Zheng J. Effect of dapagliflozin combined with entresto on heart failure after emergency intervention in patients with acute myocardial infarction[J]. Health Guide, 2024, (3): 118-120.] https://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_QKBJBD20242024032200008226.

12.冯芸, 郑杰廉. 达格列净联合诺欣妥对非糖尿病心梗后射血分数降低心力衰竭患者心功能及不良结局的影响[J]. 智慧健康, 2023, 9(15): 125-128,132.[Feng Y, Zheng JL. The effect of dapagliflozin combined with entresto on cardiac function and adverse outcomes in non-diabetic patients with reduced ejection fraction in heart failure after myocardial infarction[J]. Smart Healthcare, 2023, 9(15): 125-128, 132.] DOI: 10.19335/j.cnki.2096-1219.2023.15.028.

13.刘佳佳, 彭翔. 急性心肌梗死介入术后并发心力衰竭联合应用达格列净、诺欣妥治疗的效果分析[J]. 中国医学创新, 2023, 20(19): 52-57. [Liu JJ, Peng X. Effect analysis of combined application of dapagliflozin and entresto in the treatment of acute myocardial infarction complicated with heart failure after interventional operation[J]. Medical Innovation of China, 2023, 20(19): 52-57.] DOI: 10.3969/j.issn.1674-4985.2023.19.012.

14.徐维宁. 达格列净配合诺欣妥在非糖尿病心梗后射血分数降低心衰中的应用及病人不良事件情况分析[J/OL]. 中国科技期刊数据库医药, 2024(2) [2024-02-01]. https://www.cqvip.com/doc/journal/3338388574.

15.王艳君. 达格列净联合诺欣妥对急性心肌梗死患者急诊介入治疗后心力衰竭的疗效及安全性观察[J]. 临床研究, 2022, 30(12): 92-96. [Wang YJ. Observation on the efficacy and safety of dapagliflozin combined with norepinephrine in patients with heart failure after emergency interventional treatment of acute myocardial infarction[J]. Clinical Research, 2022, 30(12): 92-96.] DOI: 10.12385/j.issn.2096-1278(2022)12-0092-05.

16.王举红, 刘闵育. 达格列净结合诺欣妥对急性心肌梗死患者急诊介入治疗后心力衰竭的效果研究[J]. 中文科技期刊数据库（全文版）医药卫生, 2023, (5): 110-112. [Wang JH, Liu MY. Study on the effect of dapagliflozin combined with Entresto on heart failure after emergency intervention in patients with acute myocardial infarction[J]. Medicine and Health, 2023, (5): 110-112.] https://www.cqvip.com/doc/journal/2616874306.

17.李美美, 林晖莉, 陈少鹏, 等. 达格列净联合沙库巴曲缬沙坦钠治疗急性心肌梗死介入术后心力衰竭患者的临床研究[J]. 中国临床药理学杂志, 2024, 40(7): 954-958. [Li MM, Lin HL, Cheng SP, et al. Clinical trial of dapagliflozin combination with sacubitril valsartan sodium in the treatment of patients with heart failure after acute myocardial infarction intervention[J]. The Chinese Journal of Clinical Pharmacology, 2024, 40(7): 954-958.] DOI: 10.13699/j.cnki.1001-6821.2024.07.004.

18.刘红岗, 周大维. 达格列净联合诺欣妥对急性心肌梗死患者急诊介入治疗后心力衰竭的疗效观察[J]. 贵州医药, 2024, 48(2): 233-234. [Liu HG, Zhou DW. Efficacy of dapagliflozin combined with entresto in heart failure after emergency intervention in patients with acute myocardial infarction[J]. Guizhou Medical Journal, 2024, 48(2): 233-234.] https://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_guizhouyy202402023& dbid=WF_QK.

19.盛雪, 纪征, 王兆翔, 等. 达格列净联合诺欣妥对急性心肌梗死患者急诊介入治疗后心力衰竭的疗效 [J]. 实用医学杂志, 2022, 38(11): 1410-1414. [Sheng X, Ji Z, Wang ZX, et al. Effect of combination therapy with dapagliflozin and entresto on heart failure after emergency intervention in patients with acute myocardial infarction[J]. The Journal of Practical Medicine, 2022, 38(11): 1410-1414.] DOI: 10.3969/j.issn.1006-5725.2022.11.020.

20.Del Buono MG, Moroni F, Montone RA, et al. Ischemic cardiomyopathy and heart failure after acute myocardial infarction[J]. Curr Cardiol Rep, 2022, 24(10): 1505-1515. DOI: 10.1007/s11886-022-01766-6.

21.Abdelhamid M, Kandil H, Hassanin M, et al. Egyptian expert opinion for the use of sodium-glucose cotransporter-2 inhibitors in patients with heart failure with reduced ejection fraction[J]. ESC Heart Fail, 2022, 9(2): 800-811. DOI: 10.1002/ehf2.13811.

22.Blair HA. Dapagliflozin: a review in symptomatic heart failure with reduced ejection fraction[J]. Am J Cardiovasc Drugs, 2021, 21(6): 701-710. DOI: 10.1007/s40256-021-00503-8.

23.Lamacchia O, Sorrentino MR. Diabetes mellitus, arterial stiffness and cardiovascular disease: clinical implications and the influence of SGLT2i[J]. Curr Vasc Pharmacol, 2021, 19(2): 233-240. DOI: 10.2174/1570161118666200317150359.

24.Sarafidis P, Papadopoulos CE, Kamperidis V, et al. Cardiovascular protection with sodium-glucose cotransporter-2 inhibitors and mineralocorticoid receptor antagonists in chronic kidney disease: a milestone achieved[J]. Hypertension, 2021, 77(5): 1442-1455. DOI: 10.1161/HYPERTENSIONAHA.121.17005.

25.成绩, 胡豪畅, 林少沂, 等. 沙库巴曲缬沙坦治疗心血管疾病临床应用研究进展[J]. 浙江医学, 2022, 44(4): 441-446. [Cheng J, Hu HC, Lin SY, et al. Progress of research on the clinical application of sacubitril valsartan in the treatment of cardiovascular diseases[J]. Zhejiang Medical Journal, 2022, 44(4): 441-446.] DOI: 10.12056/j.issn.1006-2785.2022.44.4.2021-2570.

26.Fragin J, Stephens M. An update on heart failure: new definitions and treatment[J]. Prim Care, 2024, 51(1): 171-178. DOI: 10.1016/j.pop.2023.08.004.