Author + information
- Matthias Bossarda,b,
- Yasser Binbraika,b,
- Farzin Beyguia,b,
- Bertram Pitta,b,
- Faiez Zannada,b,
- Gilles Montalescota,b and
- Sanjit Jollya,b
Background: Although mineralocorticoid antagonists (MRA) reduce mortality in patients with heart failure (HF) complicating acute myocardial infarction (MI), it is unclear if it could be beneficial to all patients with MI. To evaluate the utility of MRA in MI patients, we performed a systematic review and meta-analysis.
Methods: MEDLINE, EMBASE and Cochrane CENTRAL were searched from 1965 to June 2016. Relevant conference abstracts were searched from 2000 to June 2016. All randomized trials (RCT) evaluating the effect of MRA after MI were included. Data were analyzed using fixed-effects models.
Results: Of 3992 citations, 8 RCTs (N=10312) were included. Of these 8 trials, 1 trial (N=6642) had heart failure (HF) as an inclusion criterion. Administration of MRA versus placebo or standard therapy after MI reduced overall and cardiovascular mortality (odds ratio [OR] 0.83 [95% confidence interval [CI] 0.73 – 0.94], p=0.004, and OR 0.82 [95%CI 0.71 – 0.93], p=0.003, respectively (I2 for both 0%)). Sensitivity analyses of HF and non-HF suggest a potential benefit in both but more data is necessary in non-HF patients (Figure). Overall, MRA therapy increased the risk for hyperkalemia (≥5.5mmol/L) (OR 1.57 [1.37 – 1.79], p<0.0001; I2 70%).
Conclusions: Administration of MRA after acute MI may reduce mortality. However, further data is required in patients presenting without HF. Therefore, a large scale randomized trial is needed to determine if this therapy is beneficial as a routine strategy in MI patients without HF.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Antiplatelet and Antithrombotic Agents in Ischemic Heart Disease
Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy
Presentation Number: 1296-313
- 2017 American College of Cardiology Foundation