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

Background. A comprehensive evaluation of the benefits of mineralocorticoid receptor antagonists (MRA) in acute myocardial infarction (AMI) patients is lacking. Objective. To summarize the evidence on the efficacy and safety of MRA in patients admitted for AMI. Methods. Articles were identified thro...

Full description

Saved in:
Bibliographic Details
Main Authors: Qiao Chen, Die Zhao, Jie Sun, Chengzhi Lu
Format: Article
Language:English
Published: Wiley 2021-01-01
Series:Cardiovascular Therapeutics
Online Access:http://dx.doi.org/10.1155/2021/1710731
Tags: Add Tag
No Tags, Be the first to tag this record!
_version_ 1832549206905061376
author Qiao Chen
Die Zhao
Jie Sun
Chengzhi Lu
author_facet Qiao Chen
Die Zhao
Jie Sun
Chengzhi Lu
author_sort Qiao Chen
collection DOAJ
description Background. A comprehensive evaluation of the benefits of mineralocorticoid receptor antagonists (MRA) in acute myocardial infarction (AMI) patients is lacking. Objective. To summarize the evidence on the efficacy and safety of MRA in patients admitted for AMI. Methods. Articles were identified through PubMed, Embase, Cochrane Library, Ovid (Medline1946-2021), and ClinicalTrials.gov databases from their inception to December 31, 2020. Results. 15 articles with a total of 11,861 patients were included. MRA reduced the risk of all-cause mortality by 16% (relative ratio (RR): 0.84; 95% confidence interval (CI) (0.76, 0.94); P=0.002) and the incidence of cardiovascular adverse events by 12% (RR: 0.88, 95% CI (0.83, 0.93), P<0.00001) in post-AMI patients, and further analysis demonstrated that early administration of MRA within 7 days after AMI resulted in a greater reduction in all-cause mortality (RR: 0.72, 95% CI (0.61, 0.85), P<0.0001). Subgroup analyses showed that post-STEMI patients without left ventricular systolic dysfunction (LVSD) treated with MRA had a 36% reduction in all-cause mortality (RR: 0.64, 95% CI (0.46, 0.89), P=0.007) and a 22% reduction in cardiovascular adverse events (RR: 0.78, 95% CI (0.67, 0.91), P=0.002). Meanwhile, post-STEMI patients without LVSD treated with MRA get significant improvements in left ventricular ejection fraction (mean difference (MD): 2.69, 95% CI (2.44, 2.93), P<0.00001), left ventricular end-systolic index (MD: -4.52 ml/m2, 95% CI (-8.21, -0.83), P=0.02), and left ventricular end-diastolic diameter (MD: -0.11 cm, 95% CI (-0.22, 0.00), P=0.05). The corresponding RR were 1.72 (95% CI (1.43, 2.07), P<0.00001) for considered common adverse events (hyperkalemia, gynecomastia, and renal dysfunction). Conclusions. Our findings suggest that MRA treatment reduces all-cause mortality and cardiovascular adverse events in post-AMI patients, which is more significant in patients after STEMI without LVSD. In addition, MRA treatment may exert beneficial effects on the reversal of cardiac remodeling in patients after STEMI without LVSD.
format Article
id doaj-art-f072f512176f4dffb717e0071ef996c4
institution Kabale University
issn 1755-5914
1755-5922
language English
publishDate 2021-01-01
publisher Wiley
record_format Article
series Cardiovascular Therapeutics
spelling doaj-art-f072f512176f4dffb717e0071ef996c42025-02-03T06:12:04ZengWileyCardiovascular Therapeutics1755-59141755-59222021-01-01202110.1155/2021/17107311710731Aldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta-AnalysisQiao Chen0Die Zhao1Jie Sun2Chengzhi Lu3The First Central Clinical School, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaDepartment of Medical Psychology, The Basic Medicine College of Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaThe First Central Clinical School, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin 300070, ChinaDepartment of Cardiology, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin 300192, ChinaBackground. A comprehensive evaluation of the benefits of mineralocorticoid receptor antagonists (MRA) in acute myocardial infarction (AMI) patients is lacking. Objective. To summarize the evidence on the efficacy and safety of MRA in patients admitted for AMI. Methods. Articles were identified through PubMed, Embase, Cochrane Library, Ovid (Medline1946-2021), and ClinicalTrials.gov databases from their inception to December 31, 2020. Results. 15 articles with a total of 11,861 patients were included. MRA reduced the risk of all-cause mortality by 16% (relative ratio (RR): 0.84; 95% confidence interval (CI) (0.76, 0.94); P=0.002) and the incidence of cardiovascular adverse events by 12% (RR: 0.88, 95% CI (0.83, 0.93), P<0.00001) in post-AMI patients, and further analysis demonstrated that early administration of MRA within 7 days after AMI resulted in a greater reduction in all-cause mortality (RR: 0.72, 95% CI (0.61, 0.85), P<0.0001). Subgroup analyses showed that post-STEMI patients without left ventricular systolic dysfunction (LVSD) treated with MRA had a 36% reduction in all-cause mortality (RR: 0.64, 95% CI (0.46, 0.89), P=0.007) and a 22% reduction in cardiovascular adverse events (RR: 0.78, 95% CI (0.67, 0.91), P=0.002). Meanwhile, post-STEMI patients without LVSD treated with MRA get significant improvements in left ventricular ejection fraction (mean difference (MD): 2.69, 95% CI (2.44, 2.93), P<0.00001), left ventricular end-systolic index (MD: -4.52 ml/m2, 95% CI (-8.21, -0.83), P=0.02), and left ventricular end-diastolic diameter (MD: -0.11 cm, 95% CI (-0.22, 0.00), P=0.05). The corresponding RR were 1.72 (95% CI (1.43, 2.07), P<0.00001) for considered common adverse events (hyperkalemia, gynecomastia, and renal dysfunction). Conclusions. Our findings suggest that MRA treatment reduces all-cause mortality and cardiovascular adverse events in post-AMI patients, which is more significant in patients after STEMI without LVSD. In addition, MRA treatment may exert beneficial effects on the reversal of cardiac remodeling in patients after STEMI without LVSD.http://dx.doi.org/10.1155/2021/1710731
spellingShingle Qiao Chen
Die Zhao
Jie Sun
Chengzhi Lu
Aldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis
Cardiovascular Therapeutics
title Aldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis
title_full Aldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis
title_fullStr Aldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis
title_full_unstemmed Aldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis
title_short Aldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis
title_sort aldosterone blockade in acute myocardial infarction a systematic review and meta analysis
url http://dx.doi.org/10.1155/2021/1710731
work_keys_str_mv AT qiaochen aldosteroneblockadeinacutemyocardialinfarctionasystematicreviewandmetaanalysis
AT diezhao aldosteroneblockadeinacutemyocardialinfarctionasystematicreviewandmetaanalysis
AT jiesun aldosteroneblockadeinacutemyocardialinfarctionasystematicreviewandmetaanalysis
AT chengzhilu aldosteroneblockadeinacutemyocardialinfarctionasystematicreviewandmetaanalysis