A randomized controlled trial to compare ramipril and sacubitril/valsartan in post-acute coronary syndrome patients with left ventricular systolic dysfunction in terms of improvement in ejection fraction


  • Gaurav Sharma Department of Pharmacology, Dr. R.P.G.M.C, Kangra, Tanda, Himachal Pradesh, India
  • Atal Sood Department of Pharmacology, Dr. R.P.G.M.C, Kangra, Tanda, Himachal Pradesh, India
  • Dinesh Kansal Department of Pharmacology, Dr. R.P.G.M.C, Kangra, Tanda, Himachal Pradesh, India
  • Mukul Kumar Department of Cardiology, Dr. R.P.G.M.C, Kangra, Tanda, Himachal Pradesh, India
  • Ambudhar Sharma Department of Cardiology, Dr. R.P.G.M.C, Kangra, Tanda, Himachal Pradesh, India
  • Sushma Sawaraj Department of Pharmacology, Dr. R.P.G.M.C, Kangra, Tanda, Himachal Pradesh, India




Sacubitril, Valsartan, Ramipril, ACS, LVEF


Background: Ramipril and sacubitril/valsartan are used in the management of ACS patients with left ventricle systolic dysfunction. The objective of the study was to compare ramipril and sacubitril/valsartan in improving LVEF in post ACS patients with LVEF <40%.

Methods: A randomized, prospective, open label, comparative study was carried out in department of pharmacology and cardiology at Dr. R. P. G. M. C. Kangra at Tanda, Himachal Pradesh. The study was carried for a period of one and a half year. Out of 80 patients, 38 patients were in ramipril group and 42 were in sacubitril/valsartan group. Data was presented as mean±SD, frequency and percentage. Student’s t test and chi square test were used and p value<0.05 was considered significant.

Results: In both the groups, a statistically significant improvement was observed in terms of improvement in LVEF at 6th month when compared to baseline, however, at 6th month both the groups were comparable in terms of LVEF improvement with p value of 0.275.

Conclusions: The study concluded that both the drugs have same efficacy in improving LVEF in post ACS patients at 6th month.


Vaduganathan M, Mensah GA, Turco JV, Fuster V, Roth GA. The Global Burden of Cardiovascular Diseases and Risk: A Compass for Future Health. J Am Coll Cardiol. 2022;80(25):2361-71.

Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, et al. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119(3):480-6.

Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet. 2008;371(9622):1435-42.

Solomon SD, Skali H, Anavekar NS, Bourgoun M, Barvik S, Ghali JK, et al. Changes in ventricular size and function in patients treated with valsartan, captopril, or both after myocardial infarction. Circulation. 2005;111(25):3411-9.

Sutton M, Pfeffer MA, Moye L, Plappert T, Rouleau JL, Lamas G, et al. Cardiovascular death and left ventricular remodeling two years after myocardial infarction: baseline predictors and impact of long-term use of captopril: information from the Survival and Ventricular Enlargement (SAVE) trial. Circulation. 1997;96(10):3294-9.

Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling--concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling. J Am Coll Cardiol. 2000;35(3):569-82.

Konstam MA, Kramer DG, Patel AR, Maron MS, Udelson JE. Left ventricular remodeling in heart failure: current concepts in clinical significance and assessment. JACC Cardiovasc Imaging. 2011;4(1):98-108.

Pfeffer MA, Braunwald E. Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications. Circulation. 1990;81(4):1161-72.

Rice GI, Jones AL, Grant PJ, Carter AM, Turner AJ, Hooper NM. Circulating activities of angiotensin-converting enzyme, its homolog, angiotensin-converting enzyme 2, and neprilysin in a family study. Hypertension. 2006;48(5):914-20.

Brunton LL, Hilal-Dandan R, Knollmann BC. Goodman and Gilman's: The Pharmacological Basis of Therapeutics. 13th ed. McGraw-Hill Education; 2018.

Drug Bank. Ramipril, 2023. Available at: URL: https://www.drugbank.ca/drugs/DB00178. Accessed on 12 May 2023.

Senni M, McMurray JJV, Wachter R, McIntyre HF, Anand IS, Duino V, et al. Impact of systolic blood pressure on the safety and tolerability of initiating and up-titrating sacubitril/valsartan in patients with heart failure and reduced ejection fraction: insights from the TITRATION study. Eur J Heart Fail. 2018;20(3):491-500.

Al-Saif SM, Alhabib KF, Ullah A, Hersi A, Alfaleh H, Alnemer K, et al. Age and its relationship to acute coronary syndromes in the Saudi Project for Assessment of Coronary Events (SPACE) registry: The SPACE age study. J Saudi Heart Assoc. 2012;24(1):9-16.

Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003;163(19):2345-53.

Peterson ED, Roe MT, Chen AY, Fonarow GC, Lytle BL, Cannon CP, et al. The NCDR ACTION Registry-GWTG: transforming contemporary acute myocardial infarction clinical care. Heart. 2010;96(22):1798-802.

Mohanan PP, Mathew R, Harikrishnan S, Krishnan MN, Zachariah G, Joseph J, et al. Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry. Eur Heart J. 2013;34(2):121-9.

Sidhu NS, Rangaiah SKK, Ramesh D, Veerappa K, Manjunath CN. Clinical Characteristics, Management Strategies, and In-Hospital Outcomes of Acute Coronary Syndrome in a Low Socioeconomic Status Cohort: An Observational Study From Urban India. Clin Med Insights Cardiol. 2020;14:1179546820918897.

Singh SS, Paul SK, Pal R, Thatkar PV. Acute coronary syndrome-related mortality audit in a teaching hospital at Port Blair, India. J Family Med Prim Care. 2017;6(3):502-8.

Himbert D, Klutman M, Steg G, White K, Gulba DC, GRACE Investigators. Cigarette smoking and acute coronary syndromes: a multinational observational study. Int J Cardiol. 2005;100(1):109-17.

Yagi H, Komukai K, Hashimoto K, Kawai M, Ogawa T, Anzawa R, et al. Difference in risk factors between acute coronary syndrome and stable angina pectoris in the Japanese: smoking as a crucial risk factor of acute coronary syndrome. J Cardiol. 2010;55(3):345-53.

Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol. 2004;43(10):1731-7.

Leong DP, Smyth A, Teo KK, McKee M, Rangarajan S, Pais P, et al. Patterns of alcohol consumption and myocardial infarction risk: observations from 52 countries in the INTERHEART case-control study. Circulation. 2014;130(5):390-8.

Fein FS. Diabetic cardiomyopathy. Diabetes care. 1990;13:1169-79.

Malmberg K, Yusuf S, Gerstein HC, Brown J, Zhao F, Hunt D, et al. Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction: results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) Registry. Circulation. 2000;102(9):1014-9.

Behl T, Sehgal A, Grover M, Singh S, Sharma N, Bhatia S, Al-Harrasi A, et al. Uncurtaining the pivotal role of ABC transporters in diabetes mellitus. Environ Sci Pollut Res Int. 2021;28(31):41533-51.

Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. New England J Med. 1998;339(4):229-34.

Avogaro A, Bonora E, Consoli A, Del Prato S, Genovese S, Giorgino F. Glucose-lowering therapy and cardiovascular outcomes in patients with type 2 diabetes mellitus and acute coronary syndrome. Diab Vasc Dis Res. 2019;16(5):399-414.

Picariello C, Lazzeri C, Attanà P, Chiostri M, Gensini GF, Valente S. The impact of hypertension on patients with acute coronary syndromes. Int J Hypertens. 2011;2011:563657.

Sharma YP, Santosh VK, Bootla D, Kanabar K, Pruthvi CR, Kaur N, et al. Epidemiological profile, management and outcomes of patients with acute coronary syndrome: Single centre experience from a tertiary care hospital in North India. Indian Heart J. 2021;73:174-9.

Negi PC, Merwaha R, Panday D, Chauhan V, Guleri R. Multicenter HP ACS Registry. Indian Heart J. 2016;68(2):118-27.

Gupta MD, Mp G, Kategari A, Batra V, Gupta P, Bansal A, et al. Epidemiological profile and management patterns of acute myocardial infarction in very young patients from a tertiary care center. Indian Heart J. 2020;72(1):32-9.

Badui E, Rangel A, Valdespino A, Graef A, Plaza A, Chavez E, et al. Acute myocardial infarct in young adults. A report of 142 cases. Archivos del Instituto de Cardiologia de Mexico. 1993;63(6):529-37.

Jering KS, Claggett B, Pfeffer MA, Granger C, Køber L, Lewis EF, et al. Prospective ARNI vs. ACE inhibitor trial to DetermIne Superiority in reducing heart failure Events after Myocardial Infarction (PARADISE-MI): design and baseline characteristics. Eur J Heart Fail. 2021;23(6):1040-8.

Rezq A, Saad M, El Nozahi M. SAcubitril/valsartan versus ramipril in patients with ST-segment Elevation Myocardial Infarction and cardiogenic SHOCK (SAVE-SHOCK): a pilot randomized controlled trial. Am J Cardiovasc Dis. 2021;11(6):734-42.




How to Cite

Sharma, G., Sood, A., Kansal , D., Kumar, M., Sharma, A., & Sawaraj , S. (2023). A randomized controlled trial to compare ramipril and sacubitril/valsartan in post-acute coronary syndrome patients with left ventricular systolic dysfunction in terms of improvement in ejection fraction. International Journal of Basic & Clinical Pharmacology, 12(4), 579–586. https://doi.org/10.18203/2319-2003.ijbcp20231895



Original Research Articles