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Aldosterone antagonists may be of benefit post-STEMI
Clinical Question
In patients with ST-elevated myocardial infarction with preserved left ventricular function, is adding an aldosterone antagonist to usual therapy effective in delaying mortality?
Bottom line
Aldosterone antagonists—spironolactone, eplerenone (Inspra), and canrenoate (Venactone, Soldactone; not available in the United States)—given acutely may have a benefit on delaying mortality in patients with ST-elevated myocardial infarction (STEMI), even in patients with preserved left ventricular function. The effect may be pronounced or quite minor, with a number needed to treat estimate ranging from 45 to 295, and we can use more studies of longer treatment. Available evidence does not show a benefit on the development of heart failure, myocardial infarction, or ventricular arrhythmia. 1a-
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Unknown/not stated
Setting: Inpatient (any location)
Synopsis
To conduct this meta-analysis, researchers followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, identifying 10 randomized clinical trials that enrolled a total of 4147 patients. All studies evaluated the effect of aldosterone antagonists in patients with STEMI without heart failure or left ventricular ejection fraction greater than 40%. Treatment following percutaneous coronary intervention, thrombolysis, or other acute treatments was associated with a lower risk of mortality, though this estimate is imprecise (number needed to treat for 6 months = 69; 95% CI 45 - 295). Treatment did not affect the rates of developing heart failure, recurrent myocardial infarction, or ventricular arrhythmia. This analysis included studies of moderate to high quality and there was no evidence of publication bias or heterogeneity (for mortality).
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
The blurb at the top of this info poem says the NNT is 45 to 295. The content of the info poem says the confidence interval is 45 to 295. These are surely not the identical same numbers! Poor editing, Info Poems!?
Good poem