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.

Objective: 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%). Methods: 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. Results: 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 Conclusion: 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.