Individual participant data analysis of two trials on aldosterone blockade in myocardial infarction

Beygui, Farzin, Van Belle, Eric, Ecollan, Patrick, Machecourt, Jacques, Hamm, Christian W, Lopez De Sa, Esteban, Flather, Marcus, Verheugt, Freek W A, Vicaut, Eric, Zannad, Faiez, Pitt, Bertram and Montalescot, Gilles (2018) Individual participant data analysis of two trials on aldosterone blockade in myocardial infarction. Heart, 104 (22). pp. 1843-1849. ISSN 1355-6037

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Abstract

Background: Two recent randomised trials studied the benefit of mineralocorticoid receptor antagonists (MRAs) in ST-segment elevation myocardial infarction (STEMI) irrespective or in absence of heart failure. The studies were both undersized to assess hard clinical endpoints. A pooled analysis was preplanned by the steering committees. Methods: We conducted a prespecified meta-analysis of patient-level data of patients with STEMI recruited in two multicentre superiority trials, randomised within 72 hours after symptom onset. Patients were allocated (1:1) to two MRA regimens: (1) an intravenous bolus of potassium canrenoate (200 mg) followed by oral spironolactone (25 mg once daily) versus standard therapy or (2) oral eplerenone (25–50 mg) versus placebo. The primary and key secondary outcomes, all-cause death and the composite of all-cause death or resuscitated sudden death, respectively, were assessed in the intention-to-treat population using a Cox model stratified on the study identifier. Results: Patients were randomly assigned to receive (n=1118) or not the MRA regimen (n=1123). After a median follow-up time of 188 days, the primary and secondary outcomes occurred in 5 (0.4%) and 17 (1.5%) patients (adjusted HR (adjHR) 0.31, 95% CI 0.11 to 0.86, p=0.03) and 6 (0.5%) and 22 (2%) patients (adjHR 0.26, 95% CI 0.10 to 0.65, p=0.004) in the MRA and control groups, respectively. There were also trends towards lower rates of cardiovascular death (p=0.06) and ventricular fibrillation (p=0.08) in the MRA group. Conclusion: Our analysis suggests that compared with standard therapy, MRA regimens are associated with a reduction of death and death or resuscitated sudden death in STEMI.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Pure Connector
Date Deposited: 12 Apr 2018 14:30
Last Modified: 22 Apr 2020 06:32
URI: https://ueaeprints.uea.ac.uk/id/eprint/66748
DOI: 10.1136/heartjnl-2018-312950

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