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...

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Autores principales:	Qiao Chen, Die Zhao, Jie Sun, Chengzhi Lu
Formato:	article
Lenguaje:	EN
Publicado:	Hindawi-Wiley 2021
Materias:	Therapeutics. Pharmacology RM1-950 Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/f072f512176f4dffb717e0071ef996c4
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spelling	oai:doaj.org-article:f072f512176f4dffb717e0071ef996c42021-11-08T02:35:40ZAldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis1755-592210.1155/2021/1710731https://doaj.org/article/f072f512176f4dffb717e0071ef996c42021-01-01T00:00:00Zhttp://dx.doi.org/10.1155/2021/1710731https://doaj.org/toc/1755-5922Background. 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.Qiao ChenDie ZhaoJie SunChengzhi LuHindawi-WileyarticleTherapeutics. PharmacologyRM1-950Diseases of the circulatory (Cardiovascular) systemRC666-701ENCardiovascular Therapeutics, Vol 2021 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Therapeutics. Pharmacology RM1-950 Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Therapeutics. Pharmacology RM1-950 Diseases of the circulatory (Cardiovascular) system RC666-701 Qiao Chen Die Zhao Jie Sun Chengzhi Lu Aldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis
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
author	Qiao Chen Die Zhao Jie Sun Chengzhi Lu
author_facet	Qiao Chen Die Zhao Jie Sun Chengzhi Lu
author_sort	Qiao Chen
title	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_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_sort	aldosterone blockade in acute myocardial infarction: a systematic review and meta-analysis
publisher	Hindawi-Wiley
publishDate	2021
url	https://doaj.org/article/f072f512176f4dffb717e0071ef996c4
work_keys_str_mv	AT qiaochen aldosteroneblockadeinacutemyocardialinfarctionasystematicreviewandmetaanalysis AT diezhao aldosteroneblockadeinacutemyocardialinfarctionasystematicreviewandmetaanalysis AT jiesun aldosteroneblockadeinacutemyocardialinfarctionasystematicreviewandmetaanalysis AT chengzhilu aldosteroneblockadeinacutemyocardialinfarctionasystematicreviewandmetaanalysis
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Aldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis

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