Patients who suffer an ST-segment elevation myocardial infarction (STEMI) have a higher chance of survival if they are treated with mineralocorticoid receptor antagonists (MRAs) in addition to standard therapy, according to research presented at the European Society of Cardiology (ESC) Congress 2017 in Barcelona, Spain. 

MRAs such as spironolactone and eplerenone are “still underused in routine clinical practice” but can be effective in countering the harms of high aldosterone levels, explained study author Professor Farzin Beygui, MD, PhD, from the ACTION Study Group. MRAs can help enhance the benefits of standard therapy, which include reperfusion therapy, beta-blockers, dual antiplatelets, ACE inhibitors, and statins.

For the study, the team of researchers pooled data from the ALBATROSS (Aldosterone Lethal effects Blockade in Acute myocardial infarction Treated with or without Reperfusion to improve Outcome and Survival at Six months follow-up) and REMINDER (Randomized, Placebo-Controlled Trial Evaluating The Safety And Efficacy Of Early Treatment With Eplerenone In Patients With Acute Myocardial Infarction) trials. The ALBATROSS study, which did not demonstrate benefit of a spironolactone-based regimen vs. standard therapy alone, did show potential in significant mortality reduction in the STEMI subgroup that researchers felt warranted more research. The REMINDER study showed that eplerenone + standard therapy administered within the first 24 hours was more effective vs. standard therapy alone in lowering a clinicobiological endpoint.

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The analysis of the two trials showed significantly reduced mortality in the MRA-treated group vs. the standard therapy group (0.4% vs. 1.6%; stratified odds ratio [OR] 0.22, 95% CI: 0.07–0.65; P=0.006).

Professor Beygui added, “The evidence from our analysis is not as strong as from a specifically designed randomized trial, however the reduction of mortality in STEMI supports the use of MRAs in this indication.” 

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