Early MRA Use in Acute MI: Is It Beneficial?

MRA in addition to standard therapy does not improve outcome in setting of post-MI heart failure
MRA in addition to standard therapy does not improve outcome in setting of post-MI heart failure

(HealthDay News) — For patients with post-myocardial infarction (MI) heart failure, mineralocorticoid receptor antagonists (MRAs) do not improve outcome, according to a study published in the April 26 issue of the Journal of the American College of Cardiology.

Farzin Beygui, MD, PhD, from the Centre Hospitalier Universitaire de Caen in France, and colleagues randomized 1,603 patients to receive either an MRA regimen with a single intravenous bolus of potassium canrenoate followed by oral spironolactone for 6 months in addition to standard therapy or to standard therapy alone. At six-month follow-up, the primary outcome was a composite of death, resuscitated cardiac arrest, significant ventricular arrhythmia, indication for implantable defibrillator, or new or worsening heart failure.

The researchers found that the primary outcome occurred in 11.8% of patients in the treatment group and 12.2% in the control group (hazard ratio, 0.97; 95% confidence interval [CI], 0.73 to 1.28), while death occurred in 1.4 and 2.1%, respectively (hazard ratio, 0.65; 95% CI, 0.30 to 1.38). The odds of death were decreased in the treatment group in a non-pre-specified exploratory analysis (0.5 versus 2.4%; hazard ratio, 0.20; 95% CI, 0.06 to 0.70) in the subgroup of ST-segment elevation MI (1,229 patients), but not in non-ST-segment elevation MI.

"The study failed to show the benefit of early MRA use in addition to standard therapy in patients admitted for MI," the authors write.

Several authors disclosed financial ties to the pharmaceutical and medical devices industries.

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