Some randomized controlled trials have compared the effectiveness and safety outcomes between early initiation of Sacubitril/Valsartan and angiotensin-converting enzyme inhibitors (ACEIs) in patients after acute myocardial infarction. Therefore, our current meta-analysis aimed to clarify the confusion. Four Databases and relevant grey literature were searched for studies from inception to July 2, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias. Four studies involving 6154 patients were included to perform meta-analysis. The results of meta-analysis showed that the left ventricular ejection fraction in the Sacubitril/Valsartan group was higher than the ACEI group (SMD: 0.37, 95% CI: 0.19–0.55, P = .000), the incidence of major adverse cardiac events in the Sacubitril/Valsartan group was lower than the ACEI group (RR: 0.61, 95% CI: 0.46–0.82, P = .001), while the incidences of cardiac death (RR: 1.00, 95% CI: 0.81–1.24, P = 1.000) and the heart failure hospitalization (RR: 0.62, 95% CI: 0.37–1.03, P = .065) showed no difference. For the incidences of myocardial infarction and the adverse side effects, there was no obvious advantage of the Sacubitril/Valsartan group over the ACEI group, because the meta-analysis was not performed due to the limited trials. This study indicated that early initiation of Sacubitril/Valsartan in patients after acute myocardial infarction was superior to ACEI in reducing the risks of major adverse cardiac events and left ventricular ejection fraction increasing. As for the other outcomes (the incidences of cardiac death, the heart failure hospitalization, the myocardial infarction and the adverse side effects), Sacubitril/Valsartan showed no obvious advantage than ACEI.

中文翻译：

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急性心肌梗死后早期开始使用沙库巴曲/缬沙坦的疗效和安全性：一项荟萃分析

一些随机对照试验比较了急性心肌梗死后患者早期开始使用沙库巴曲/缬沙坦和血管紧张素转换酶抑制剂 (ACEI) 的有效性和安全性结果。因此，我们当前的荟萃分析旨在澄清这一困惑。检索了四个数据库和相关灰色文献，查找从建库到2021年7月2日的研究。两名评审员独立筛选文献、提取数据并评估偏倚风险。纳入了涉及 6154 名患者的四项研究来进行荟萃分析。Meta分析结果显示，沙库巴曲/缬沙坦组的左心室射血分数高于ACEI组（SMD：0.37，95% CI：0.19-0.55，P  = .000），主要心脏不良事件的发生率较高。沙库巴曲/缬沙坦组的事件发生率低于 ACEI 组（RR：0.61，95% CI：0.46-0.82，P  = 0.001），而心源性死亡的发生率（RR：1.00，95% CI：0.81-1.24） ，P  = 1.000）和心力衰竭住院（RR：0.62，95% CI：0.37-1.03，P  = .065）没有差异。对于心肌梗死的发生率和不良副作用，沙库巴曲/缬沙坦组相对于ACEI组没有明显优势，因为试验有限，没有进行荟萃分析。这项研究表明，急性心肌梗死后患者早期开始使用沙库巴曲/缬沙坦在降低主要不良心脏事件和左心室射血分数增加的风险方面优于 ACEI。至于其他结局（心源性死亡、心力衰竭住院、心肌梗死和不良副作用的发生率），沙库巴曲/缬沙坦与ACEI相比没有明显优势。