Coronary disease & ACSSecondary analysis
Cardiovascular events after acute myocardial infarction complicated by low ejection fraction and/or congestion: a landmark analysis of the PARADISE-MI trial
- Secondary analysis of the PARADISE-MI randomised trial
- post hoc
- landmark analysis
Authors' conclusion
Post-AMI, HF predominates both early and late among CV events.
Study context
- Population
- Patients with AMI complicated by left ventricular systolic dysfunction (LVSD) and/or pulmonary congestion, randomised at a mean of 4 days post-AMI
- Participants
- 5,661 patients
- Comparison
- Sacubitril/valsartan vs ramipril
- Primary endpoint
- Timing and distribution of CV events, and treatment effects in early (≤ 3 months) and late (> 3 months) post-AMI periods
Primary result
As reported in the abstract
CV event rates post-AMI
- Early: Heart failure (HF)
- 16.2/100 patient-years (py)
- Early: Cardiovascular (CV) death
- 11.6/100 py
- Early: recurrent MI
- 10.9/100 py
- Late: HF vs MI (p=0.008)
- 3.2/100 py vs. 2.6/100 py
- Late: CV death
- 2.1/100 py
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Recurrent MI, late post-AMI · > 3 months | 0.76 (0.60–1.00) | P = 0.05 | |
| Expanded CV composite (CV death, HF events, recurrent MI, hospitalization for angina, or post-randomization coronary revascularization) · over the trial | 0.87 (0.77–0.97) | P = 0.012 | |
| 0.512Hazard ratio (log scale) |
Patient profiles, HF vs recurrent MI
- Early: similar profiles
- Late: HF patients older, more often female, more pulmonary congestion, lower eGFR; recurrent MI patients more prior coronary revascularization
Original publication
Cardiovascular events after acute myocardial infarction complicated by low ejection fraction and/or congestion: a landmark analysis of the PARADISE-MI trial. Eur J Heart Fail. Published 22 May 2026. doi:10.1093/ejhf/xuag176
Summarised from the published abstract; every number is checked against it