Mineralocorticoid receptor antagonists in patients with acute myocardial infarction — A systematic review and meta-analysis of randomized trials

Bossard, Matthias; Binbraik, Yasser; Beygui, Farzin; Pitt, Bertram; Zannad, Faı̈ez; Montalescot, Gilles; Jolly, Sanjit S.

doi:10.1016/j.ahj.2017.09.010

Cited by 22 publications

(15 citation statements)

References 38 publications

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“…Comparing our results with previously published articles, we found that treatment with an aldosterone antagonist for patients with acute myocardial infarction, heart failure, diabetic nephropathy, resistant hypertension, or other cardiovascular-related diseases has similar benefits and also results in similar adverse effects [29–32].…”

Section: Discussionsupporting

confidence: 78%

Aldosterone Antagonists Reduce the Risk of Cardiovascular Mortality in Dialysis Patients: A Meta-Analysis

Xie

Liang

2019

Evidence-Based Complementary and Alternative Medicine

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Background and Purpose. Cardiovascular disease is the major cause of death in dialysis patients. Although aldosterone antagonists were considered a treatment for severe heart failure patients to reduce cardiac mortality, whether treating patients undergoing maintenance dialysis with aldosterone antagonists could reduce the risk of cardiocerebrovascular (CCV) remains unclear. We aim to systematically assess the efficacy and tolerability of the addition of aldosterone antagonists to conventional therapy in patients undergoing maintenance dialysis. Materials and Methods. We searched PubMed, EMBASE, the Cochrane Library, the Chinese Biomedical Literature Database (CBM), and the China National Knowledge Infrastructure (CNKI) for relevant articles. The primary endpoint of interest was CCV mortality. The secondary endpoints were all-cause mortality, left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF). Publication bias was evaluated using funnel plots and Egger’s test. The meta-analysis was performed using Review Manager software version 5.3. Results. This analysis included 10 randomized controlled trials (RCTs) with 1172 total chronic dialysis patients. The use of aldosterone antagonists in the dialysis population resulted in a marked reduction in CCV mortality (RR 0.42, 95% CI 0.26-0.65, P=0.0002) and all-cause mortality (RR0.46, 95%CI 0.32-0.66, P<0.0001). The LVEF was improved by treatment with aldosterone antagonists (WMD 6.35%, P<0.00001). Moreover, aldosterone antagonists decreased the LVMI (WMD -8.69 g/m2, P=0.0006), whereas aldosterone antagonists increased the occurrence of hyperkalemia (RR1.70, 95%CI 1-2.88, P=0.05) and gynecomastia (RR 8.01, 95% CI 2.44- 26.27, P=0.0006). Conclusions. Addition of aldosterone antagonists to conventional treatment in chronic dialysis patients may reduce CCV mortality, improve cardiac function, and simultaneously decrease LVMI.

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Section: Discussionsupporting

confidence: 78%

Aldosterone Antagonists Reduce the Risk of Cardiovascular Mortality in Dialysis Patients: A Meta-Analysis

Xie

Liang

2019

Evidence-Based Complementary and Alternative Medicine

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“…The results from the pooled studies 20 and meta-analyses21., 22. and our study support the need for an adequately powered study and the CLEAR-SYNERGY (NCT03048825) study (4000 patients; primary endpoint: composite of cardiovascular death or new or worsening heart failure at 2 years) has been designed to address this and is currently recruiting patients.…”

Section: Discussionsupporting

confidence: 66%

“…A recent pooled analysis from the ALBATROSS and REMINDER trials reported that there were significantly fewer deaths in the MRA-treated patients when compared to controls after a median of 6 months follow-up 20 . Two large meta-analyses recently showed that the mortality benefit was mainly in those patients with post-MI heart failure 21 as well as in STEMI patients without heart failure 22 . The beneficial effects of MRA therapy on mortality could be partly due to less adverse LV remodeling, a pre-cursor of heart failure and our study provides further support for the use of MRA therapy in STEMI patients.…”

Section: Discussionmentioning

confidence: 99%

Mineralocorticoid receptor antagonist pre-treatment and early post-treatment to minimize reperfusion injury after ST-elevation myocardial infarction: The MINIMIZE STEMI trial

Bulluck¹,

Fröhlich²,

Nicholas³

et al. 2019

American Heart Journal

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Background Mineralocorticoid receptor antagonist (MRA) therapy has been shown to prevent adverse left ventricular (LV) remodeling in ST-segment elevation myocardial infarction (STEMI) patients with heart failure. Whether initiating MRA therapy prior to primary percutaneous coronary intervention (PPCI) accrues additional benefit of reducing myocardial infarct size and preventing adverse LV remodeling is not known. We aimed to investigate whether MRA therapy initiated prior to reperfusion reduces myocardial infarct (MI) size and prevents adverse LV remodeling in STEMI patients. Methods STEMI patients presenting within 12 hours and with a proximal coronary artery occlusion with Thrombolysis In Myocardial Infarction flow grade 0 were consented and randomized to either an intravenous bolus of potassium canrenoate, followed by oral spironolactone for 3 months or matching placebo. The primary endpoint was MI size by cardiovascular magnetic resonance at 3 months. Results Sixty-seven patients completed the study. There was no significant difference in the final MI size at 3 months between the 2 groups (placebo: 17 ± 11%, MRA: 16 ± 10%, P = .574). There was also no difference in acute MI size (26 ± 16% versus 23 ± 14%, P = .425) or myocardial salvage (26 ± 12% versus 24 ± 8%, P = .456). At follow-up, there was a trend towards an improvement in LVEF (placebo: 49 ± 8%, MRA: 54 ± 11%, P = .053), and the MRA group had significantly greater percentage decrease in LVEDV (mean difference: −12.2 (95% CI −20.3 to −4.4)%, P = .003) and LVESV (mean difference: −18.2 (95% CI −30.1 to −6.3)%, P = .003). Conclusion This pilot study showed no benefit of MRA therapy in reducing MI size in STEMI patients when initiated prior to reperfusion, but there was an improvement in LV remodeling at 3 months. Adequately powered studies are warranted to confirm these findings.

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“…Among those without HF, the mortality rate was 2.5% in acute MI patients treated with MRAs versus 3.5% among those without MRAs ( P = .43). [29] Chen et al [30] found that MRAs treatment reduced hospitalization for HF and caused quantifiable improvements in quality of life, diastolic function, and reversal of cardiac remodeling in HF in patients with preserved ejection fractions but did not provide any all-cause mortality benefit. Others studies, in agreement with ours, found that MRAs had all-cause mortality benefits and cardiac benefits in post-MI patients with LVD.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of mineralocorticoid receptor antagonists in postmyocardial infarction patients with or without left ventricular dysfunction

Qiu

Yang

et al. 2018

Medicine

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Mineralocorticoid receptor antagonists in patients with acute myocardial infarction — A systematic review and meta-analysis of randomized trials

Cited by 22 publications

References 38 publications

Aldosterone Antagonists Reduce the Risk of Cardiovascular Mortality in Dialysis Patients: A Meta-Analysis

Aldosterone Antagonists Reduce the Risk of Cardiovascular Mortality in Dialysis Patients: A Meta-Analysis

Mineralocorticoid receptor antagonist pre-treatment and early post-treatment to minimize reperfusion injury after ST-elevation myocardial infarction: The MINIMIZE STEMI trial

Efficacy of mineralocorticoid receptor antagonists in postmyocardial infarction patients with or without left ventricular dysfunction

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