Key result
Mineralocorticoid receptor antagonist therapy initiated prior to reperfusion did not significantly reduce myocardial infarct size at 3 months compared to placebo (16% vs 17%; P=0.574).
Why the study?
Whether initiating mineralocorticoid receptor antagonist therapy prior to primary percutaneous coronary intervention reduces myocardial infarct size and prevents adverse LV remodeling in STEMI patients was unknown.
Does mineralocorticoid receptor antagonist therapy initiated prior to reperfusion reduce myocardial infarct size and prevent adverse LV remodeling in STEMI patients?
RCT (n=67)
Randomized
Does mineralocorticoid receptor antagonist therapy initiated prior to reperfusion reduce myocardial infarct size and prevent adverse LV remodeling in STEMI patients?
Absolute Event Rate: 16% vs 17%
p-value: p=.574
Initiating mineralocorticoid receptor antagonist therapy prior to reperfusion in STEMI does not reduce myocardial infarct size, though it may improve left ventricular remodeling at 3 months.
BACKGROUND: Mineralocorticoid receptor antagonist (MRA) therapy has been shown to prevent adverse left ventricular (LV) remodeling in ST-segment elevation myocardial infarction (STEMI) patients with heart failure. Whether initiating MRA therapy prior to primary percutaneous coronary intervention (PPCI) accrues additional benefit of reducing myocardial infarct size and preventing adverse LV remodeling is not known. We aimed to investigate whether MRA therapy initiated prior to reperfusion reduces myocardial infarct (MI) size and prevents adverse LV remodeling in STEMI patients. METHODS: STEMI patients presenting within 12 hours and with a proximal coronary artery occlusion with Thrombolysis In Myocardial Infarction flow grade 0 were consented and randomized to either an intravenous bolus of potassium canrenoate, followed by oral spironolactone for 3 months or matching placebo. The primary endpoint was MI size by cardiovascular magnetic resonance at 3 months. RESULTS: Sixty-seven patients completed the study. There was no significant difference in the final MI size at 3 months between the 2 groups (placebo: 17 ± 11%, MRA: 16 ± 10%, P = .574). There was also no difference in acute MI size (26 ± 16% versus 23 ± 14%, P = .425) or myocardial salvage (26 ± 12% versus 24 ± 8%, P = .456). At follow-up, there was a trend towards an improvement in LVEF (placebo: 49 ± 8%, MRA: 54 ± 11%, P = .053), and the MRA group had significantly greater percentage decrease in LVEDV (mean difference: -12.2 (95% CI -20.3 to -4.4)%, P = .003) and LVESV (mean difference: -18.2 (95% CI -30.1 to -6.3)%, P = .003). CONCLUSION: This pilot study showed no benefit of MRA therapy in reducing MI size in STEMI patients when initiated prior to reperfusion, but there was an improvement in LV remodeling at 3 months. Adequately powered studies are warranted to confirm these findings.
No takes yet. Share an insight, caveat, or question.
Bulluck et al. (2019) conducted an RCT in ST-elevation myocardial infarction (STEMI) (n=67). Mineralocorticoid receptor antagonist (MRA) therapy vs. Matching placebo was evaluated on Myocardial infarct size by cardiovascular magnetic resonance at 3 months (p=.574). Mineralocorticoid receptor antagonist therapy initiated prior to reperfusion did not significantly reduce myocardial infarct size at 3 months compared to placebo (16% vs 17%; P=0.574).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: