Early Aldosterone Blockade in Acute Myocardial Infarction

Beygui, Farzin; Cayla, Guillaume; Roule, Vincent; Roubille, François; Delarche, Nicolas; Silvain, Johanne; Belle, Éric Van; Belle, Loïc; Galinier, Michel; Motreff, Pascal; Cornillet, Luc; Collet, Jean‐Philippe; Furber, Alain; Goldstein, Patrick; Ecollan, Patrick; Legallois, Damien; Lebon, Alain; Rousseau, Hélène; Machecourt, J; Zannad, Faı̈ez; Vicaut, Éric; Montalescot, Gilles

doi:10.1016/j.jacc.2016.02.033

Cited by 102 publications

(75 citation statements)

References 23 publications

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“…Because the ALBATROSS trial suggested that early aldosterone antagonism might be beneficial in patients with ST elevation myocardial infarction without heart failure,18 we performed a sensitivity analysis on the 1757 patients who presented with ST elevation myocardial infarction. Similar to the full cohort, a doubling of aldosterone was not associated with the primary composite endpoint in this subset of patients (hazard ratio 0.91, 95% CI 0.70‐1.19, P =0.48).…”

Section: Resultsmentioning

confidence: 99%

Aldosterone Does Not Predict Cardiovascular Events Following Acute Coronary Syndrome in Patients Initially Without Heart Failure

Pitts

Gunzburger

Ballantyne

et al. 2017

JAHA

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BackgroundAldosterone may have adverse effects in the myocardium and vasculature. Treatment with an aldosterone antagonist reduces cardiovascular risk in patients with acute myocardial infarction complicated by heart failure (HF) and left ventricular systolic dysfunction. However, most patients with acute coronary syndrome do not have advanced HF. Among such patients, it is unknown whether aldosterone predicts cardiovascular risk.Methods and ResultsTo address this question, we examined data from the dal‐OUTCOMES trial that compared the cholesteryl ester transfer protein inhibitor dalcetrapib with placebo, beginning 4 to 12 weeks after an index acute coronary syndrome. Patients with New York Heart Association class II (with LVEF <40%), III, or IV HF were excluded. Aldosterone was measured at randomization in 4073 patients. The primary outcome was a composite of coronary heart disease death, nonfatal myocardial infarction, stroke, hospitalization for unstable angina, or resuscitated cardiac arrest. Hospitalization for HF was a secondary endpoint. Over a median follow‐up of 37 months, the primary outcome occurred in 366 patients (9.0%), and hospitalization for HF occurred in 72 patients (1.8%). There was no association between aldosterone and either the time to first occurrence of a primary outcome (hazard ratio for doubling of aldosterone 0.92, 95% confidence interval 0.78‐1.09, P=0.34) or hospitalization for HF (hazard ratio 1.38, 95% CI 0.96‐1.99, P=0.08) in Cox regression models adjusted for covariates.ConclusionsIn patients with recent acute coronary syndrome but without advanced HF, aldosterone does not predict major cardiovascular events.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00658515.

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Section: Resultsmentioning

confidence: 99%

Aldosterone Does Not Predict Cardiovascular Events Following Acute Coronary Syndrome in Patients Initially Without Heart Failure

Pitts

Gunzburger

Ballantyne

et al. 2017

JAHA

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“…This acute damage is followed by gradual repair with fibrosis. 6,27,28 Whether this strategy improves outcomes in patients without systolic dysfunction or symptomatic heart failure is yet to be determined. 23,24 Myocardial fibrosis may represent a major pathway leading to adverse remodelling, cardiac dysfunction, and worse prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…The non-infarct zone exhibits reactive hypertrophy, interstitial fibrosis, and increased collagen, potentially leading to cardiac dysfunction. 27,28 Natriuretic peptides, such as BNP, are produced by cardiomyocytes and may be increased by cardiac and atrial stretch, and also by other factors, such as renal impairment or atrial fibrillation. 25,26 Thus, identifying patients more prone to adverse remodelling and DD may help clinicians in tailoring treatments with anti-adverse remodelling properties.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic diastolic function evolution in patients with an anterior Q‐wave myocardial infarction: insights from the REVE‐2 study

et al. 2018

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AimsMyocardial fibrosis plays a key role in the development of adverse left ventricular remodelling after myocardial infarction (MI). This study aimed to determine whether the circulating levels of BNP, collagen peptides, and galectin‐3 are associated with diastolic function evolution (both deterioration and improvement) at 1 year after an anterior MI.Methods and resultsThe REVE‐2 is a prospective multicentre study including 246 patients with a first anterior Q‐wave MI. Echocardiographic assessment was performed at hospital discharge and ±1 year after MI. BNP, galectin‐3, and collagen peptides were measured ±1 month after MI. Left ventricular diastolic dysfunction (DD) was defined according to the presence of at least two criteria of echocardiographic parameters: septal e′ < 8 cm/s, lateral e′ < 10 cm/s, and left atrial volume ≥ 34 mL/m2. At baseline, 87 (35.4%) patients had normal diastolic function and 159 (64.6%) patients had DD. Follow‐up of 61 patients among the 87 patients with normal diastolic function at baseline showed that 22 patients (36%) developed DD at 1 year post‐MI. The circulating levels of amino‐terminal propeptide of type III procollagen > 6 mg/L [odds ratio (OR) = 5.29; 95% confidence interval (CI) = 1.05–26.66; P = 0.044], galectin‐3 > 13 μg/L (OR = 5.99; 95% CI = 1.18–30.45; P = 0.031), and BNP > 82 ng/L (OR = 10.25; 95% CI = 2.36–44.50; P = 0.002) quantified at 1 month post‐MI were independently associated with 1 year DD. Follow‐up of the 137 patients with DD at baseline among the 159 patients showed that 36 patients (26%) had a normalized diastolic function at 1 year post‐MI. Patients with a BNP > 82 ng/L were less likely to improve diastolic function (OR = 0.06; 95% CI = 0.01–0.28; P = 0.0003).ConclusionsThe present study suggests that circulating levels of amino‐terminal propeptide of type III procollagen, galectin‐3, and BNP may be independently associated with new‐onset DD in post‐MI patients.

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“…В дальнейшем в ходе выполнения РКИ АLBATROSS (Aldosterone Lethal effects Blocked in Acute MI Treated with or without Reperfusion to improve Outcome and Survival at Six months follow-up) оценивали эффективность применения альдостерона по сравнению с плацебо в ранние сроки после развития ОИМпST у больных с сохраненной ФВ ЛЖ [20]. В это исследование также было включено относительно небольшое число больных (n=1603), что, как и в исследовании REMINDER, затрудняло получение положительных результатов вследствие недостаточной статистической мощности.…”

Section: новые данные о прогностическом значении и роли повышения биоunclassified

New Clinical Aspects of Eplerenone Use in Clinical Practice

Gilyarevskiy

Бенделиани

Голшмид

et al. 2018

Racionalʹnaâ farmakoterapiâ v kardiologii

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The problem of the discrepancy between convincing evidences of the effectiveness of the use of mineralocorticoid receptor antagonists in patients with heart failure with reduced left ventricular ejection fraction and insufficiently frequent their use in clinical practice for the treatment of these patients is considered in the article. Experts opinions on the reasons for this discrepancy are also presented. New data on the effectiveness of the use of the mineralocorticoid receptor antagonist, eplerenone, in some clinical situations identified in the analysis of subgroups of participants in a large randomized clinical trial EMPHASIS-HF are discussed. The main goal of this study was to evaluate the efficacy of eplerenone compared with placebo in patients with heart failure and reduced left ventricular function. In addition, experimental animal studies, which may indicate the pleiotropic effects of eplerenone in patients with vascular diseases, are presented. The new data on the effectiveness of eplerenone in subgroups of patients with heart failure and certain characteristics may be an additional reason to draw the attention of physicians to the benefits of its use and, accordingly, its more frequent application in clinical practice for the treatment of patients with clear indications for this therapy.

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Early Aldosterone Blockade in Acute Myocardial Infarction

Abstract: The study failed to show the benefit of early MRA use in addition to standard therapy in patients admitted for MI. (Aldosterone Lethal effects Blockade in Acute myocardial infarction Treated with or without Reperfusion to improve Outcome and Survival at Six months follow-up; NCT01059136).

Cited by 102 publications

References 23 publications

Aldosterone Does Not Predict Cardiovascular Events Following Acute Coronary Syndrome in Patients Initially Without Heart Failure

Aldosterone Does Not Predict Cardiovascular Events Following Acute Coronary Syndrome in Patients Initially Without Heart Failure

Echocardiographic diastolic function evolution in patients with an anterior Q‐wave myocardial infarction: insights from the REVE‐2 study

New Clinical Aspects of Eplerenone Use in Clinical Practice

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