OBJECTIVES : To evaluate clinical efficacy and safety of treatments used in HF prevention in (1) AMI patients and (2) AMI patients with left ventricular systolic dysfunction (LVSD) and/or pulmonary congestion (those at high risk of progression to HF).

METHODS : A systematic search in accordance with PRISMA guidelines was conducted on CENTRAL, Embase® and MEDLINE® databases since their inception till November 5th 2019. Search terms included were (variations of) ‘myocardial infarction (MI)’, ‘HF’, ‘angiotensin-converting enzyme inhibitors (ACE-Is)’, ‘angiotensin receptor blockers (ARBs)’ ‘mineralocorticoid receptor antagonists (MRAs)’ ‘sacubitril/valsartan’, and ‘randomized controlled trials’. The outcomes included HF prevention (primary), mortality, recurrent cardiovascular [CV] and composite events, echocardiographic parameters, adverse events [AEs], and discontinuations.

RESULTS : Of 5,617 citations, 26 unique studies met inclusion criteria. The majority of publications were old with over 60% published in 1990s. The mean age of the population varied from 56.0–67.7 years. ACE-Is were the most commonly investigated intervention (14). In AMI+LVSD trials, ~70.0% patients had Killip class ≥II and left ventricular ejection fraction cut-offs were 45%, 40% and 35%. In placebo-controlled trials (19) of AMI population, ACE-Is demonstrated a significant reduction in HF onset, mortality and composite endpoints whereas results were non-significant for MRAs. In placebo-controlled trials (7) with an AMI+LVSD population, ACE-Is showed a significant reduction in mortality, HF onset, sudden cardiac deaths (SCDs) and CV hospitalizations. Eplerenone (MRA) reduced HF hospitalization and SCD significantly. In an active-controlled trial, valsartan was non-inferior to captopril across outcomes. Common AEs reported across trials were cough, hypotension, and hyperkalemia. Discontinuations were lower in ARB treatment arms.

CONCLUSIONS : The evidence base supports current usage of ACE-Is and ARBs to prevent HF in post-AMI patients with LVSD and also in general post-AMI population. However, trials are relatively old, which limits comparability with new studies due to changes in treatment practice, diagnostics and patient characteristics.