Effects of aldosterone blockade on left ventricular function and clinical status during acute myocardial infarction

Abstract

In concordance with these findings, the ejection fraction was slightly higher in Group A than in Group B, although this was not statistically significant (47% versus 44%). This trend continued during a 6-month follow-up after randomization. Our findings suggest that early administration of aldosterone blockers provides additional benefits after AMI, reducing the incidence of post-MI angina pectoris and rhythm and conduction disturbances.

Impact of Aldosterone Antagonists on Sudden Cardiac Death Prevention in Heart Failure and Post-Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…All trials were placebo controlled except three trials [ 22 ][ 23 ][ 24 ] which applied routine treatment. Nine trials [ 25 ][ 26 ][ 27 ][ 28 ][ 13 ][ 29 ][ 30 ][ 31 ][ 24 ] assessed the effect of AAs in post-AMI patients with left ventricular dysfunction; while the other trials recruited HF patients. Duration of follow-up varied from 3 to 44 months.…”

The effects of spironolactone on atrial remodeling in patients with preserved left ventricular function after an acute myocardial infarction

“…Thus, reproducibility of the results in patients taking optimal medical therapy with antiremodeling effects was unclear. Uzunhasan et al [21] have reported that LV EF and volumes did not change in AMI patients who were using optimal medical therapy including angiotensin converting enzyme inhibitors and b blockers compared with additional spironolactone therapy during the 6-month follow-up. Weir et al [19] have found only the modest beneficial effect of eplerenone on LV remodeling in a cohort of patients with LV systolic dysfunction early after AMI.…”

Aldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis

“…Nine RCTs [ 11 , 12 , 18 – 22 , 25 , 28 ] involving 10,702 post-AMI patients showed a significant 14% reduction (10.61% in the MRA groups vs. 12.04% in the control groups) in new or worsening heart failure (HF) after MRA treatment ( Figure 6 ). Excluding the EPHESUS trial [ 11 ] with a weight of 79.9%, RR resulted in no statistical significance: from (0.86, 95% CI (0.77, 0.95), P =0.004, I 2 = 0%) to (0.83, 95% CI (0.65, 1.05), P =0.12, I 2 = 0%).…”

“…Data were pooled using a fixed effects model, when I 2 values were below 50%; otherwise, a random effects model was used. If similar estimates were obtained by both [18] Randomized, placebo Yes 12 5 Italy Pitt (2003) [11] Randomized, double-blind, placebo Yes 16 7 Multiple Hayashi (2003) [19] Randomized, nonplacebo No 1 6 Japan Di Pasquale (2001) [20] Randomized, double-blind, placebo No 6 5 Italy Di Pasquale (2005) [21] Randomized, double-blind, placebo No 6 5 Italy Uzunhasan (2009) [22] Randomized, double-blind, placebo Yes 6 7 Turkey Kayrak (2010) [23] Randomized, nonplacebo No 6 5 Turkey Weir (2011) [24] Randomized, double-blind, placebo No 5.5 7 UK Kampourides (2012) [25] Randomized, open-labeled, nonplacebo No 24 6 Greece Wu (2013) [26] Randomized, placebo No 12 6 China Vatankulu (2013) [27] Randomized, nonplacebo Yes 6 5 Turkey Montalescot (2014) [28] Randomized, double-blind, placebo Yes 10.5 7 Multiple Beygui (2016) [12] Randomized, open-labeled, blinded endpoint, nonplacebo Yes 6 5 Multiple Bulluck (2019) [13] Randomized, double-blinded, placebo Yes 3 7 UK ITTA: intention to treat analysis. 3 Cardiovascular Therapeutics methods, we only reported the random effects results to cover possible heterogeneity, because three drugs and different patients were included particularly in control groups.…”

“…We found 4338 potentially articles, among which 15 trials [11][12][13][17][18][19][20][21][22][23][24][25][26][27][28] involving 11,861 individuals were included (Figure 1). Treatment duration ranged from 1 to 24 months (8:40 ± 5:77).…”