Early addition of low-dose spironolactone (20 mg/d) to standard therapy significantly improved left ventricular ejection fraction and reduced cardiac remodeling at one year in patients with first-onset STEMI.
RCT (n=616)
Randomly divided
No
Does low-dose spironolactone improve cardiac remodeling in patients after acute myocardial infarction?
Early addition of low-dose spironolactone to conventional therapy post-AMI improves echocardiographic markers of cardiac remodeling at 1 year without significantly increasing hyperkalemia or renal dysfunction.
Absolute Event Rate: 54.86% vs 52.35%
p-value: p=0.0153
BACKGROUND: Few studies have reported the effect of aldosterone receptor antagonist (ARA) on myocardial remodeling after acute myocardial infarction (AMI). This study was undertaken to investigate the preventive effect of ARA on myocardial remodeling after AMI. METHODS: A total of 616 patients who had been admitted into the CCU of the First Affiliated Hospital of Harbin Medical University from January 2008 to January 2010 were studied prospectively. Only 528 patients were observed completely, including 266 of the control group and 262 of the treatment group. There was no statistical difference in age, gender, medical history, admission situation, and treatment between the two groups (P>0.05). The preventive effects of spironolactone on cardiac remodeling, left ventricular function, renal function and blood levels of potassium were evaluated by echocardiography, serum potassium and serum creatinine at one-month and one-year follow-up. RESULTS: The echocardiography indicators such as LVESD, LVEDD, LVEF, LAD-ML and LAD-SI were significantly improved in the treatment group compared with the control group at one year (P<0.05). In the treatment group, LVESD, LVEDD, LVPWT, LVEF, LAD-ML and LAD-SI were more significantly improved at one year than one month (P<0.05, P=0.007 to LVEF), and in the control group LVEF was more significantly improved at one year than one month (P=0.0277). There were no significant differences in serum potassium and serum creatinine levels between the two groups. CONCLUSION: On the basis of conventional treatment, the early combination of low-dose spironolactone (20 mg/d) could inhibit cardiac remodeling at late stage and prevent heart failure.
Wu et al. (Tue,) conducted a rct in Acute myocardial infarction (STEMI) (n=616). Spironolactone vs. Standard therapy was evaluated on Left ventricular ejection fraction (LVEF) at 12 months (p=0.0153). Early addition of low-dose spironolactone (20 mg/d) to standard therapy significantly improved left ventricular ejection fraction and reduced cardiac remodeling at one year in patients with first-onset STEMI.
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