Bossard M, et al. - Systematic review and meta-analysis was performed to assess the utility of mineralocorticoid antagonists (MRA) in myocardial infarction (MI) patients. As per the evidence, MRA may attenuate mortality post-acute MI. However, this was largely based on post-MI patients with heart failure.

Methods

• Researchers searched MEDLINE, EMBASE and Cochrane CENTRAL from 1965 to June 2016.
• They also searched conference abstracts from 2000 to June 2016.
• This study included randomized trials (RCT) evaluating the effect of MRA after MIs.
• Two reviewers independently extracted data and assessed study quality.
• Fixed-/random-effects models were used to combine data.

Results

• This analysis included 11 RCTs (N = 11,258), one trial (N = 6642) included patients with apparent heart failure(Killip class III-IV).
• Findings demonstrated that administration of MRA versus placebo or standard therapy (no-MRA) after MI attenuated overall and cardiovascular mortality (odds ratio[OR] 0.82 [95% confidence interval[CI] 0.73–0.93],P = .002, and OR 0.82 [95%CI 0.71–0.93],P = .003,respectively (I2 for both = 0%)).
• Researchers found that in the subgroup of trials with patients with heart failure, the mortality was 14.4% in MRA group versus 16.7% in no MRA group (OR 0.84 [95%CI 0.73–0.96], and among those without heart failure, 2.5% with MRA versus 3.5% without MRA (OR 0.72 [95%CI 0.51–1.02],p-for-interaction = 0.43).
• Fewer new or worsening heart failure events were reported for patients receiving MRA (OR 0.74 [0.66–0.84],P < .0001;I² = 14%).
• Nevertheless, it was evident that MRA therapy increased risk for hyperkalemia (≥5.5 mmol/L) (OR 2.52 [95% CI 1.36–4.65],P = .003;I² = 63%).